tag:blogger.com,1999:blog-65846280827285499752024-03-13T00:09:33.863-07:00晉熯的物理治療臨床日誌Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-6584628082728549975.post-1828704810210594842017-10-23T10:11:00.004-07:002017-10-23T10:12:27.452-07:00肩膀痛跟胸椎有關係嗎?(作者:高于惠 物理治療師)<div class="ParaAttribute4" style="line-height: 115%;">
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<span class="CharAttribute3"><span style="line-height: 115%;"><span style="color: orange; font-size: x-large;">[作者:高于惠 物理治療師]</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">肩膀「拉傷」好不了?復原的最後一哩路在動作控制!</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">大家應該有過這種經驗:平時做一個比較大的動作卻突然有「拉到」的感覺,有的人休息一下就好了、有的人卻拖了一陣子或者一直無法完全痊癒。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">這次要分享的案例就是肩膀受傷後的故事</span></span><span class="CharAttribute0"><span lang="EN-US" style="line-height: 115%;">……</span></span><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Arial;"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;"><span style="color: orange;">陳先生於一年多前開車時,右手往後座伸手突然一陣抽痛無力,拉傷後即使經過休息,肩痛仍一直無法痊癒,也曾尋求過民俗療法協助,有改善症狀卻無法持久且完全</span>;走進診間,對於物理治療其實也是抱持著姑且一試的想法,希望能夠解決困擾許久的症狀。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">檢視陳先生的症狀,出現於<span style="color: orange;">手臂上舉</span>與<span style="color: orange;">肩膀內外旋</span>的動作時,在<span style="color: orange;">右肩後側靠近關節縫處疼痛</span>,並且伴隨著<span style="color: orange;">無力感</span>。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">進行全身性的評估後,發現其<span style="color: orange;">胸椎第二節錯位</span>與<span style="color: orange;">異常的肩胛肱骨節律對其症狀影響最明顯</span>,另外的胸小肌、前鋸肌與肩胛下肌也十分緊繃。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">因此治療重點便是<span style="color: orange;">針對胸椎錯位調整</span>、持續放鬆緊繃的肌肉、合併肩關節與肩胛骨的鬆動,並且<span style="color: orange;">指導平時姿勢的修正</span>,而除了<span style="color: orange;">徒手治療之外更重要的便是動作控制</span>!</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">後面治療多著重在<span style="color: orange;">肩胛骨動靜態的控制</span>,<span style="color: orange;">並漸進的加上不同變化以達到接近功能性的動作,如此才能讓個案後續的狀況更上一層樓!</span></span></span><span lang="EN-US"><span style="color: orange;"><o:p></o:p></span></span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">圖一:肩胛骨控制合併肩關節外轉<br /></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: 新細明體, serif; font-size: 11pt; line-height: 16.8667px;">圖二:訓練肩胛骨動態穩定之上肢功能性動作訓練</span><span class="CharAttribute0" style="font-size: small; text-align: start;"><span lang="EN-US" style="font-size: 11pt; line-height: 16.8667px;"> (PNF</span></span><span class="CharAttribute0" style="font-size: small; text-align: start;"><span style="font-family: 新細明體, serif; font-size: 11pt; line-height: 16.8667px;">的</span></span><span class="CharAttribute0" style="font-size: small; text-align: start;"><span lang="EN-US" style="font-size: 11pt; line-height: 16.8667px;">D2F)<br /></span></span></td></tr>
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<span style="color: orange; font-size: large;"><span class="CharAttribute4"><span style="line-height: 115%;">「為什麼肩膀痛跟胸椎錯位會有關係呢?」</span></span></span></div>
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<span style="font-size: large;"><span lang="EN-US"><o:p></o:p></span></span><span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">一個簡單把手往後伸的動作,包含了肩關節的後伸、外展與外轉三個平面的動作,除此之外還有頸椎和胸椎的旋轉,所以於整體評估都是會一併檢查。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;"><span style="color: orange;">症狀未必會直接出現錯位的胸椎</span>,以神經生理學的觀點,<span style="color: orange;">大腦對於傳入訊息的解讀若有誤便會使患者主觀感覺症狀出現於其他地方</span>,以此例便是肩膀。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">當然,肩膀本身還是有些問題的,以動作來看,極有可能在陳先生向後伸手時胸椎的旋轉就卡住了,旋轉的受限使肩關節必須做出更大角度以完成向後取物的目的。</span></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">肩膀為了做到更極限的動作而造成附近肌群緊繃,隨著因疼痛而不敢動作與時間拉長,附近筋膜也一併鎖住了。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute4"><span style="line-height: 115%;"><span style="color: orange;"><b>為什麼光調整錯位、放鬆肌肉「好抹完全」?</b></span></span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span class="CharAttribute3"><span style="line-height: 115%;">在受傷之後,我們用力的方式、大腦傳遞訊息與神經肌肉的連結其實會改變,即使直接解決掉錯位的胸椎與軟組織放鬆,<span style="color: orange;">如果沒有重新教導患者正確的動作控制,便容易因為身體不當的出力方式而使問題持續存在。</span></span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span class="CharAttribute3"><span style="line-height: 115%;"><span style="color: orange; font-size: large;"><b>物理治療的目的在於,找出您的問題根源點之外,也讓您重</b></span></span></span></div>
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<span class="CharAttribute3"><span style="line-height: 115%;"><span style="color: orange; font-size: large;"><b>新</b></span></span></span><b style="color: orange; font-size: x-large;">學會如何正確使用您的身體!</b></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-15098664696105877762017-10-23T05:32:00.000-07:002017-10-23T10:35:35.256-07:00老師,我無法阻止我的腰大肌瘋狂地反覆緊起來? (作者:蔡馨儀 物理治療師)<div class="MsoNormal">
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<b style="font-family: helvetica, arial, sans-serif; font-size: xx-large;"><span style="color: orange;">[作者:蔡馨儀 物理治療師]</span></b></div>
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /><br /><br /><span style="font-size: large;">幾個禮拜前</span></span><span style="font-size: large;"><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">來了一位張先生</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">主述是自從某次<span style="color: orange;">跳舞過程中發生類似閃到腰</span>的狀況後</span><span lang="EN-US">,</span><span style="color: orange; font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左邊的腰大肌一直有緊繃感</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不管怎麼放鬆或是接受治療都一樣,甚至有時<span style="color: orange;">疼痛</span>發作,嚴重一點會<span style="color: orange;">影響呼吸和食慾。</span></span><span lang="EN-US" style="color: orange;"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">進行動作評估時</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">發現</span><span lang="EN-US">:<o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">1.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">站姿下</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">軀幹向右側彎與左邊髖關節在各方向的主動動作不足</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">並感到<b><span style="color: red;">左邊腰大肌</span></b>深層拉緊的感覺</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">2.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">平躺下被動的髖關節屈曲左邊小於右邊</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">3.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: red; font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右邊的</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第一節腰椎活動度過低</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">4.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="color: red; font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右邊的</span></b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腰方肌也較左邊緊</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="color: orange;">治療右邊第一節腰椎的當下</span>,張先生就感覺到全身有放鬆的感覺,而且治療</span><span lang="EN-US">3</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘後,<span style="color: orange;">軀幹和髖關節各方向的動作都得到大幅度的改善,左邊的腰大肌也不會感到緊繃了。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">重點是,當他回去<span style="color: orange;">持續自我放鬆右邊第一節腰椎後,他的食慾和呼吸也獲得了大幅的改善</span>,在下次回診時,他說他從來沒感受過身體這麼輕鬆的感覺,也說過,之前放鬆其他點都是有時有效、有時沒效,但這個右腰腰椎第一節的放鬆</span>
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">卻讓他的狀況持續有進步。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了解開患者的卡住的<span style="color: orange;">根源點</span>以外,還必須做<span style="color: orange;">腰椎和骨盆的動作控制訓練</span>,幫助他跳舞時的動作控制或是日常生活的各種動作。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif";">透過懸吊系統與站姿下的動作測試後,發現</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="color: orange; font-size: large;"><span lang="EN-US">1.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左腳單腳站的能力弱於右腳</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span style="color: orange;"><span lang="EN-US">2.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif";">右邊腰方肌和左邊大腿內收肌的動作控制特別弱</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當我們試著不做任何放鬆,直接訓練右邊腰方肌和大腿內收肌的動作控制後</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">軀幹向右側彎和左髖各方向的動作所產生的不適改善了九成</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">甚至張先生覺得他有長高、身體比較正的感覺,甚至平常蹲下時右腳髕骨發出的聲音也變小聲了。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但是</span><span lang="EN-US">!<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">張先生一直很疑惑</span><span lang="EN-US">……<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">“</span><span style="color: orange;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為什麼我的不適在左邊</span> <span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但其實問題點在右邊</span><span lang="EN-US">?”<o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span style="color: orange;"><span lang="EN-US">“</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而且為什麼放鬆右腰第一節連食慾和呼吸都變好了</span></span><span lang="EN-US"><span style="color: orange;">?</span>”<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">嘿嘿</span><span lang="EN-US">~~</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">以下為大家解惑囉</span><span lang="EN-US">~~<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">其實當我們在治療患者時常常要看整體的姿勢和動作</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而不是只有看緊繃點,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因為有時產生緊繃感的肌肉是被拉扯而導致的緊,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">另外也有可能是從其他地方轉移過來的轉移痛而已</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了轉移痛以外,肌肉筋膜的相連也是有相互關係的</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">1.<span style="font-stretch: normal; line-height: normal;"> </span></span><span style="color: orange;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">人體的腰大肌,腰方肌和橫膈肌是共享同一個筋膜並附著在腰椎第</span><span lang="EN-US">1~3</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">節附近</span><span lang="EN-US">(</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span></span><span lang="EN-US"><span style="color: orange;">)</span><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmr7tZR8Hq3P2F7V_grHO5vgmEwTIIJcp-h_SouFglSS7WkWDDdbw7tDfogr3SL65tSYeN5nLsvEgY-vIqNaQ6wj5EaJljwGGEQKr9ekOpAVY_L5wn_WkBagPA1jhabgHc5drZCqCWC-VD/s1600/1508757491641.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="303" data-original-width="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmr7tZR8Hq3P2F7V_grHO5vgmEwTIIJcp-h_SouFglSS7WkWDDdbw7tDfogr3SL65tSYeN5nLsvEgY-vIqNaQ6wj5EaJljwGGEQKr9ekOpAVY_L5wn_WkBagPA1jhabgHc5drZCqCWC-VD/s1600/1508757491641.jpg" /></span></a></div>
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<span style="font-size: large;"><span lang="EN-US">2.<span style="font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span style="color: orange;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腰大肌前方也與腸胃的筋膜相連</span><span lang="EN-US">(</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如下圖</span><span lang="EN-US">)</span></span> </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlecBm2EGUTkuUVqFV_BM-qv1h90wRrHjaA5b13bPH-1V34BXrl_7MdqfIpqBdiMsaLuJVhkqksLfdqb6uCyOfxFe9vbsp0wJ4JTgMsJiGBzjXoZz06ONUy5ZmpLK8LtLBhhiJ3iRxVyca/s1600/1508757540689.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="273" data-original-width="322" height="271" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlecBm2EGUTkuUVqFV_BM-qv1h90wRrHjaA5b13bPH-1V34BXrl_7MdqfIpqBdiMsaLuJVhkqksLfdqb6uCyOfxFe9vbsp0wJ4JTgMsJiGBzjXoZz06ONUy5ZmpLK8LtLBhhiJ3iRxVyca/s320/1508757540689.jpg" width="320" /></span></a></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">來看張先生的狀況,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">雖然他不記得一開始怎麼閃到腰的,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">無法從受傷機制去分析,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但是<span style="color: orange;">大腦</span>是個很有趣的器官,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當一個傷害產生的時候,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">他會啟動另一種代償機制來保護受傷的位置,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="color: orange; font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">避免疼痛更加劇,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而這種動作模式通常不會因為受傷組織的恢復而消失,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所以從動作評估是可以找出這些線索的</span><span lang="EN-US">~<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">線索一</span><span lang="EN-US">:</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">張先生的關節活動度在向右側彎同時骨盆向左側移的活動度過小</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">線索二</span><span lang="EN-US">:</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左腳單腳站的能力弱於右腳</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">線索三</span><span lang="EN-US">:</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右邊腰方肌和左邊大腿內收肌的動作控制特別弱</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">先別說太多,大家先看以下這張圖,是否有發現一些有趣的關聯</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYmT4R5YKaU3X9Av0A_z00UQk6KYRC6gPyGmeyPgVtOOzHJlMCAOhgMi6bq7zVpQxz46UzRm3CXsyVebGaUvM3UZuj5FaPMJ3hg4pxqnD5XSKbudtQM4CX25HGsckI8hic_9WtU_bIl71-/s1600/1508757567940.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="317" data-original-width="172" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYmT4R5YKaU3X9Av0A_z00UQk6KYRC6gPyGmeyPgVtOOzHJlMCAOhgMi6bq7zVpQxz46UzRm3CXsyVebGaUvM3UZuj5FaPMJ3hg4pxqnD5XSKbudtQM4CX25HGsckI8hic_9WtU_bIl71-/s640/1508757567940.jpg" width="347" /></span></a></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></span>
<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">可能因為當時閃到腰的現象</span> <span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">讓張先生骨盆時常卡在向右側移的位置,</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">也讓左側下肢的承重減少進而抑制左側內收肌與臀中肌的使用,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></span><br />
<span style="font-family: , serif; font-size: large;">大家可以試試看,</span><span style="font-family: , serif; font-size: large;">如果你在站姿或坐姿下都把重心移到右側,是不是感覺左側腹部的肌肉都呈現拉長拉緊的現象,作誇張一點如下圖:</span><span lang="EN-US" style="font-size: large;">(</span><span style="font-family: "新細明體" , "serif"; font-size: large;">六塊肌不是重點</span><span style="font-size: large;"> </span><span style="font-family: "新細明體" , "serif"; font-size: large;">請大家不要模糊焦點</span><span lang="EN-US" style="font-size: large;">XD)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgspOqYZYpMCK8dbcV7RFNWikIg34E1a3n0k7zP1-AwQSUKGig2Yn4oQGnT3Zs12FzbVUifVadDkTFfFEdCNx5zfeAp2tRCMsjpbieey0sj1xIknc1i3RA-0OOVWIEgpUd2HBkES0wP8le8/s1600/1508757625372.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="311" data-original-width="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgspOqYZYpMCK8dbcV7RFNWikIg34E1a3n0k7zP1-AwQSUKGig2Yn4oQGnT3Zs12FzbVUifVadDkTFfFEdCNx5zfeAp2tRCMsjpbieey0sj1xIknc1i3RA-0OOVWIEgpUd2HBkES0wP8le8/s1600/1508757625372.jpg" /></span></a></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />當<span style="color: orange;">左側肌肉都呈現比較拉長的狀態時,這種緊繃感和不適感就會出現了</span></span><span lang="EN-US" style="color: orange;">!<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所以你還會覺得左邊的腰大肌或髂腰肌是需要被放鬆或伸展的嗎</span><span lang="EN-US">?<o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">從完整的動作評估與檢測</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">幫助您找出問題的根源點</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">訓練神經肌肉中的弱連結</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: orange; font-family: "新細明體" , "serif"; font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">維持骨骼肌肉系統的穩定</span><span lang="EN-US"><span style="color: orange; font-size: large;">!</span><o:p></o:p></span><br />
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</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖二</span><span lang="EN-US">:<a href="https://goo.gl/sFyRRP" target="_blank"><span style="color: #ff8000; font-family: "helvetica" , "sans-serif";">https://goo.gl/sFyRRP</span></a><o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖三</span><span lang="EN-US">:http://www.drdooleynoted.com/anatomy-angel-lateral-subsystem/<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="color: #444444; font-family: "新細明體" , "serif"; mso-ascii-font-family: Helvetica; mso-bidi-font-family: Helvetica; mso-bidi-font-size: 12.0pt; mso-font-kerning: 0pt; mso-hansi-font-family: Helvetica;">圖四</span><span lang="EN-US" style="color: #444444; font-family: "helvetica" , "sans-serif"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 新細明體; mso-font-kerning: 0pt;">:</span><span lang="EN-US"><a href="https://goo.gl/1yJUbE" target="_blank"><span style="color: #4f9d9d; font-family: "helvetica" , sans-serif; text-decoration-line: none;">https://goo.gl/1yJUbE</span></a><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US"><a href="http://robertsontrainingsystems.com/blog/the-deep-front-line/">http://robertsontrainingsystems.com/blog/the-deep-front-line/</a><o:p></o:p></span></div>
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<strong><span style="background: white; color: #404040; font-family: "新細明體" , "serif";">備註五的參考文字</span></strong><strong><span lang="EN-US" style="background: white; color: #404040; font-family: "helvetica" , "sans-serif";">:<o:p></o:p></span></strong></div>
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<strong><span lang="EN-US" style="background: white; color: #404040; font-family: "helvetica" , "sans-serif";">Deep Front Line</span></strong><span lang="EN-US"><o:p></o:p></span></div>
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<strong><span lang="EN-US" style="background: white; color: #404040; font-family: "helvetica" , "sans-serif";">Posterior tibialis</span></strong><span lang="EN-US" style="background: white; color: #404040; font-family: "helvetica" , "sans-serif";"> > interosseuos membrane > Knee
capsule > adductor hiatus > intermuscular septum > femoral triangle
> <strong>psoas</strong> >
anterior longitudinal ligament > <strong>diaphragm</strong> >
pericardium > mediastinum > parietal pleura > fascia prevertebralis
> <strong>scalenes<o:p></o:p></strong></span></div>
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<b><span lang="EN-US" style="background: yellow; color: red; font-family: "helvetica" , "sans-serif";">The Diaphragm, Psoas,
and Quadratus lumborum (QL) share a fascial connection at the lumbar vertebrae</span></b><span lang="EN-US" style="background: white; color: #404040; font-family: "helvetica" , "sans-serif";">. When proper diaphragmatic breathing is
not observed, these muscles are prone to disuse, weakness and trigger point
development – all of which can play a role in back and hip pain.</span><span lang="EN-US"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-17534381364680198012017-07-12T06:05:00.001-07:002017-10-23T09:58:42.575-07:00甩手功甩到肩夾擠,問題竟然出現在頸椎?!(作者:蔡馨儀 物理治療師)<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: x-large;">甩手功甩到肩夾擠,問題竟然出現在頸椎</span></span><span lang="EN-US"><span style="font-size: x-large;">?!</span><o:p></o:p></span></b></div>
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<span lang="EN-US"><span style="font-size: large;">作者:蔡馨儀 物理治療師</span></span></div>
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<span style="font-size: large;">晉熯脊骨物理治療所</span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">今天來了一個甩手功甩到右側肩膀突然大痛的牛小姐</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJRM0PLTumKGEf_8IYV0YrA-bAn1sqhnqfTO_q5V2UAOrI4mn4Lxf2tAfAepLhbl6t1-x3sgFgYD6Hx9Qpj2gpZcQDqI0MrjHPVaJlGlCYktNLMl3ByYIh0qivxHExcXLCyKhmyZcR5Kby/s1600/1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="400" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJRM0PLTumKGEf_8IYV0YrA-bAn1sqhnqfTO_q5V2UAOrI4mn4Lxf2tAfAepLhbl6t1-x3sgFgYD6Hx9Qpj2gpZcQDqI0MrjHPVaJlGlCYktNLMl3ByYIh0qivxHExcXLCyKhmyZcR5Kby/s640/1.jpg" width="532" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">圖一 示意圖</td></tr>
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<span style="font-size: large;"><span lang="EN-US">“</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="color: orange;">我發現我肩膀突然舉到一個角度後就會刺痛,而且無法扣內衣,甚至突然一個動作也會引發疼痛</span></span><span lang="EN-US">”<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">觀察動作以及主述都像是一個</span><span lang="EN-US">”</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肩關節夾擠</span><span lang="EN-US">”</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的個案</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但事情不單純</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因為牛小姐本身有<span style="color: orange;">頸椎第六、七節的椎間盤突出和第五節腰椎的椎弓斷裂</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所以就思考到,很可能肩膀的不適是來自脊椎的關係</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但必須先排除肩膀有沒有局部結構性的受傷</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了做一些特殊測試外,也有請牛小姐去做<span style="color: orange;">超音波檢查</span></span><span lang="EN-US"><span style="color: orange;"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="color: orange;">發現並無肌腱或韌帶撕裂傷的問題</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">評估結果</span><span lang="EN-US">:<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">1. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肩膀活動度測試</span><span lang="EN-US">:</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右側肩關節外展、屈曲、內轉活動度不足</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">2. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">上肢張力測試</span><span lang="EN-US">:</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右大於左</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">3. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右邊的第</span><span lang="EN-US">2-5</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頸椎的小面關節活動度過小,有局部肌肉痙攣的現象</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">4. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">前斜角肌、提肩胛肌、胸小肌、肱二頭肌肌肉張力高右於左側</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">5. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肩胛骨、肩膀、手臂的肌肉張力也是高的</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">動作測試發現</span><span lang="EN-US">:<o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span lang="EN-US">“ </span></b><span style="color: orange;"><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當把第</span><span lang="EN-US">2</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頸椎往左側移</span><span lang="EN-US">(Cervical
Lateral Glides)</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">時,同時請個案舉手時,</span></b></span></span><b><span style="font-family: , serif;"><span style="color: orange; font-size: large;">發現角度增加了疼痛程度也大幅下降了 。</span></span><span lang="EN-US" style="font-size: large;">”</span></b></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在<span style="color: orange;">降低頸椎的神經張力後肩膀各方向的角度都增加了,疼痛程度也下降一半以上</span></span><span lang="EN-US"><span style="color: orange;">!</span><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">評估結果顯示不是甩手功的錯</span> <span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">也不是肩膀的問題</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">也不是核磁共振顯示的第六七頸椎椎間盤突出的問題</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">圖二 示意圖</td></tr>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這就跟要一個有下背痛的患者用不對的姿勢去搬重物一樣</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頸椎負荷過大</span> <span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">神經就崩潰了</span><span lang="EN-US">!<o:p></o:p></span></span></div>
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<span style="color: orange; font-size: large;"><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">疼痛問題的根源往往在你意想不到的地方</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: orange;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">仔細的評估</span> <span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">才能達到有效率的治療</span></span></b><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">(</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">本文為個案分享</span> <span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">同樣的狀況有不同的原因</span>
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">有任何問題請請教專業的物理治療師幫您做詳細的評估</span></span><span lang="EN-US"><span style="font-size: large;">)</span><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源</span><span lang="EN-US">:<o:p></o:p></span></b></div>
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<span lang="EN-US">1. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖一</span><span lang="EN-US">:http://s10.sinaimg.cn/mw690/0040xicqty6H12B99YB59&690<o:p></o:p></span></div>
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<span lang="EN-US">2. </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖二</span><span lang="EN-US">:
http://anatomybody101.com/wp-content/uploads/2015/11/human-anatomy<o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-67479015361179393252017-03-28T04:22:00.000-07:002017-03-28T04:24:24.677-07:00長期姿勢不良,媽媽手找上門<div class="MsoNormal" style="text-align: center;">
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<span style="font-size: large;"><b>作者:高于惠 物理治療師</b></span></div>
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<span style="font-size: large;"><b>晉熯脊骨物理治療所</b></span></div>
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<span style="font-size: large;"><span style="line-height: 115%;">「媽媽手」,常見於家庭主婦而得名,也可能出現在常需使用手腕之工作,如肉販、廚師<span lang="EN-US">…</span>等。疼痛發生於手腕橈側處,主因為外展拇長肌<span lang="EN-US">(abductor pollicis
longus,APL)</span>與伸拇短肌<span lang="EN-US">(extensor pollicis brevis,EPB)</span>的過度使用,造成腱鞘發炎而疼痛。一般以「</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; line-height: 115%;">Finkelstein’s test</span><span style="line-height: 115%;">」此特殊測試確診之。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large; line-height: 115%;">但是,有些時候<span style="color: orange;"><span lang="EN-US">…</span>導致疼痛的根源點<span lang="EN-US">(</span>病灶<span lang="EN-US">)</span>卻不一定就是在疼痛點本身</span><span lang="EN-US"><span style="color: orange;">…</span><o:p></o:p></span></span></div>
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<span style="font-size: large; line-height: 115%;">日前,有位程先生走進診間,面露擔憂之色,主述其<span style="color: orange;">右手腕橈側處疼痛已久,無法彎曲握拳,甚至影響執筆寫字</span>。<span lang="EN-US"><o:p></o:p></span></span><br />
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<span style="font-size: large;"><span style="color: orange; line-height: 115%;">經醫師診斷為媽媽手</span><span style="line-height: 115%;">,因疼痛未見改善,後經轉介到本治療所求診。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large; line-height: 115%;"><br /></span><span style="font-size: large; line-height: 115%;"> 我們對個案進行完整的理學評估,檢查各個關節,如頸椎、肩膀以及其他手部關節進行動作測試發現...<span lang="EN-US"><o:p></o:p></span></span><br />
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<span style="font-size: large;"><span lang="EN-US" style="line-height: 115%;">1. </span><span style="line-height: 115%;">右手腕尺側屈曲<span lang="EN-US">(wrist ulnar deviation)</span>受限且疼痛。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="line-height: 115%;">2. </span><span style="line-height: 115%;">大拇指掌指關節的屈曲動作受限且疼痛。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="line-height: 115%;">3. </span><span style="line-height: 115%;">大拇指打開的動作<span lang="EN-US">(pollicis abduction)</span>有明顯無力感。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large;"><span style="line-height: 115%;"> 經測試評估後,發現放鬆右側胸小肌、前臂屈肌群,可讓手腕和大拇指角度活動增加,同時疼痛感大幅下降,尤以<span style="color: orange;">胸小肌</span>效果為佳。<span lang="EN-US"><o:p></o:p></span></span></span><br />
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<span style="font-size: large;"><span lang="EN-US" style="line-height: 115%;"> </span><span style="line-height: 115%;">因此確定這位個案<span style="color: orange;">手腕疼痛<span lang="EN-US">(</span>媽媽手<span lang="EN-US">)</span>的根源點便是右邊胸小肌導致的</span>。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: large; line-height: 115%;">在此個案中,評估測試後,<span style="color: orange;">媽媽手症狀的根源點竟然不是手腕橈側肌肉,卻是胸小肌<span lang="EN-US">!!! </span></span>為什麼呢<span lang="EN-US">?<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="line-height: 115%;">依據神經生理學的概念,<span style="color: orange;">疼痛代表的其實是一種警示訊號,而身體產生的疼痛也是經過大腦解讀後的結果。</span></span><b><span lang="EN-US" style="color: blue; font-family: "times new roman" , "serif"; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<span style="font-size: large; line-height: 115%;">程先生因為工作需要長時間坐辦公室打電腦,又<span style="color: orange;">姿勢不良,聳肩駝背</span>。長時間靜態的姿勢讓人身體僵緊,鎖在不正確的姿勢下,使<span style="color: orange;">身體前側和手臂筋膜鎖緊</span>,就像整隻手被橡皮筋纏得緊緊的,當然會很不舒服囉!<span lang="EN-US"><o:p></o:p></span></span><br />
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<span style="font-size: large;"><span style="line-height: 115%;">這時候如果沒有找出造成大腦判讀為疼痛的</span><span style="font-family: "新細明體" , "serif"; line-height: 115%;">「</span><span style="line-height: 115%;">根源點」,只是反覆處理外展拇長肌與伸拇短肌的話,則無法有效解決其疼痛。<span lang="EN-US"><o:p></o:p></span></span></span><br />
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<span style="font-size: large; line-height: 115%;">所以治療重點是找到問題的根源點,改善動作品質,進而讓疼痛消失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="line-height: 115%;">物理治療師是治療疼痛的專家,幫您找出問題的根源點,改善生活品質!</span></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYF9j8K7Pwf-7HkJyFAvOKeJRc4QNwnCaVLu39uA4mvJqf4W4dpJfbL1p5T_y8aQdi-ruM0a_umSczWlx3CwdH6H2VKpGY1Uszw_kagWhix45i7YKesEhZPHj4kGnM_DmdBJm_6phXUNx7/s1600/%25E5%259C%2596%25E7%2589%2587_%25E5%25AA%25BD%25E5%25AA%25BD%25E6%2589%258B1arm+line.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYF9j8K7Pwf-7HkJyFAvOKeJRc4QNwnCaVLu39uA4mvJqf4W4dpJfbL1p5T_y8aQdi-ruM0a_umSczWlx3CwdH6H2VKpGY1Uszw_kagWhix45i7YKesEhZPHj4kGnM_DmdBJm_6phXUNx7/s320/%25E5%259C%2596%25E7%2589%2587_%25E5%25AA%25BD%25E5%25AA%25BD%25E6%2589%258B1arm+line.jpg" style="cursor: move;" width="228" /></a></div>
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<span style="font-size: large;"><span style="line-height: 115%;">來看看鎖緊手臂的橡皮筋<span lang="EN-US">~</span></span><span lang="EN-US" style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="line-height: 115%;">圖片來</span></span><span style="font-size: large; text-indent: 24.1pt;">源:</span><br />
<span style="font-size: large;"><span lang="EN-US"><a href="https://goo.gl/images/hjXhlc"><span style="background: white; color: #1155cc; line-height: 115%;">https://goo.gl/images/hjXhlc</span></a><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="background: white; color: #222222; font-family: "arial unicode ms" , "sans-serif"; line-height: 115%;">《<span lang="EN-US">Anatomy
Trains</span>》<span lang="EN-US">3rd edition</span></span></span><span lang="EN-US"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-84733341970989549882017-03-06T02:15:00.000-08:002017-03-06T02:16:08.005-08:00為什麼我的高爾夫球肘都好不了?<div class="MsoNormal" style="text-align: right;">
<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b><span style="font-size: large;">作者:蔡馨儀 物理治療師</span></b></span></div>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b><span style="font-size: large;">晉熯脊骨物理治療所</span></b></span></div>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">陳小姐,愛好打高爾夫球,擁有</span><span lang="EN-US">10</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的球齡,這次就診是希望解決每次打完球,左手手肘內側就會緊繃的狀況,除此之外,她也練了</span><span lang="EN-US">5</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月的瑜珈,然而在兩週前練下犬式</span><span lang="EN-US"> (</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US">1) </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">時,左手手肘會覺得緊緊痠痠的。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBw62ErOo7dxAxPFOvX-KCfuH9ybbcl_HuhSPi4E5oriU3hWUyYSUZ2BcSNVOaNG8JwOXCtmMUU2elPBWDVJDR1rwwzhCrU3zfviuYz9xuMmFJduZ98kVRpteyKVw_zpK7FjjRNXLSZyii/s1600/%25E4%25B8%258B%25E7%258A%25AC%25E5%25BC%258F.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBw62ErOo7dxAxPFOvX-KCfuH9ybbcl_HuhSPi4E5oriU3hWUyYSUZ2BcSNVOaNG8JwOXCtmMUU2elPBWDVJDR1rwwzhCrU3zfviuYz9xuMmFJduZ98kVRpteyKVw_zpK7FjjRNXLSZyii/s320/%25E4%25B8%258B%25E7%258A%25AC%25E5%25BC%258F.jpg" width="320" /></a></span></div>
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<span style="font-size: large;"><span style="font-family: 新細明體, serif;">圖</span><span lang="EN-US">1.
</span><span style="font-family: 新細明體, serif;">圖片來源</span><span lang="EN-US">:</span><span lang="EN-US"><a href="https://goo.gl/RV6R7g" target="_blank"><span style="color: #ff8000; font-family: Helvetica, sans-serif;">https://goo.gl/RV6R7g</span></a></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了</span><span lang="EN-US">10</span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的球齡,她也擁有</span><span lang="EN-US">10</span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的下背痛病史</span></b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,久坐久站也會痠痛,為了<b>想了解兩者的關聯</b>,當然要鉅細靡遺地、打破砂鍋地問到底囉</span><span lang="EN-US">! <o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span lang="EN-US" style="color: red;">“</span></b><b><span style="color: red; font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">下背痛是打球後才出現的嗎</span><span lang="EN-US" style="color: red;">?”<o:p></o:p></span></b></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">陳小姐聽到立刻控訴辦公室的久坐環境</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">哀</span><span lang="EN-US">~</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">立刻為台灣久坐久站的勞工環境默哀了三秒鐘再回神繼續聽</span><span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">10</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年前就已經照過斷層掃描</span><span lang="EN-US">(CT)</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">被醫生診斷過腰椎第</span><span lang="EN-US">4</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span><span lang="EN-US">5</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">之間椎間盤突出,當時是建議開刀的,但她不想開所以就去做復健,不過也沒有完全解決,就與下背痛共生了</span><span lang="EN-US">10</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年歲月。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<b><span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">開始了一連串的動作評估,發現</span><span lang="EN-US">:<o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><span style="font-size: large;"><b><span lang="EN-US" style="color: red; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">1.<span style="font-stretch: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腰椎向左旋轉到底在後下髂棘</span><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US">2)</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的地方會疼痛</span><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">她稱之為平常痠痛的痛點</span><span lang="EN-US">)</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,而且<b><span style="color: red;">旋轉角度小於右邊</span></b></span><b><span lang="EN-US" style="color: red;"><o:p></o:p></span></b></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">2.<span style="font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">臀部向左右側移的動作都會引發同樣的痛點</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">3.<span style="font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當場做<b><span style="color: red;">下犬式的動作就會有手肘內側緊繃</span></b>的現象,但單純再站立下以手掌撐床的動作是不會誘發疼痛的</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="display: none; font-family: Arial, sans-serif;">4.</span><!--[endif]--><span style="display: none; font-family: 新細明體, serif;">表單的頂端</span><span lang="EN-US" style="display: none; font-family: Arial, sans-serif;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="display: none; font-family: Arial, sans-serif;">5.</span><!--[endif]--><span style="display: none; font-family: 新細明體, serif;">表單的底部</span><span lang="EN-US" style="display: none; font-family: Arial, sans-serif;"><o:p></o:p></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">做了幾個治療性測試後發現,當<b>抑制左邊的梨狀肌後腰部的動作全部改善了</b>,而且疼痛都消失了,不過下犬式引發手肘內側疼痛的狀況依舊存在。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不論是下犬式或是高爾夫球運動後的痠痛都顯示,陳小姐都是在<b>動態下或是某個特定的姿勢下才會誘發疼痛的,代表<span style="color: red;">動作控制出</span>了問題。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span style="color: red; font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">高爾夫球是個身體的轉動同步手部的上下轉擺動的組合動作</span><span lang="EN-US" style="color: red; mso-bidi-font-weight: bold;">(</span></b><b><span style="color: red; font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US" style="color: red;">3)</span></b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,重點在於,從事這項運動必須要有穩定的動力鍊,利用下肢與腰部的大肌肉將力量穩穩傳送到手部,若單純只有手部,很容易有各種代償的動作,造成壓力點最後在某一個特定的關節上。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span><span lang="EN-US">3. </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片來源</span><span lang="EN-US">:<a href="https://goo.gl/kb0ohB" target="_blank"><span style="color: #4f9d9d; font-family: "Helvetica","sans-serif";">https://goo.gl/kb0ohB</span></a><o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所以</span><span lang="EN-US">!!!</span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為了確認到底是哪一條動力鍊出了問題,運用了</span><span lang="EN-US">redcord</span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">懸吊系統來評估,發現</span><span lang="EN-US">!!<o:p></o:p></span></b></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">1.<span style="font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右邊的<b><span style="color: red;">臀大肌和臀中肌</span></b>在下肢承重時是無法有效率的穩定骨盆</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><span lang="EN-US">2.<span style="font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右手的<b><span style="color: red;">肱三頭</span></b>在手掌支撐吊繩時,會感到無力。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">面對下犬式造成的手臂不適,我選擇訓練</span><span lang="EN-US">kneeling scapular protraction</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,因為與下犬式的姿勢相似,除了要<b><span style="color: red;">有好的上肢控制還要有穩定的核心</span></b></span><b><span lang="EN-US" style="color: red;">(</span></b><b><span style="color: red; font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US" style="color: red;">4)</span></b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6Cp1EvPXN6SODxrJVnGKHFB2Ma4W1KoYM77CpOAaebzfnbv2_oEkXO3uCHiRhQUiWPX14-rP0f1tvNNfUmv6FntDltGo9qqA7j343PLbq9DKj3rUTNHrx1G1jeITb3iG2idlpDYsG23x/s1600/4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr6Cp1EvPXN6SODxrJVnGKHFB2Ma4W1KoYM77CpOAaebzfnbv2_oEkXO3uCHiRhQUiWPX14-rP0f1tvNNfUmv6FntDltGo9qqA7j343PLbq9DKj3rUTNHrx1G1jeITb3iG2idlpDYsG23x/s320/4.jpg" width="320" /></span></a></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span><span lang="EN-US">4. </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片來源</span><span lang="EN-US">:<span style="color: #4f9d9d; font-family: "Helvetica","sans-serif";"><a href="https://goo.gl/tHkwDU" target="_blank">https://goo.gl/tHkwDU</a></span><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">每個動作</span><span lang="EN-US">5</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">秒重複</span><span lang="EN-US">3~5</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次,重複</span><span lang="EN-US">3</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">回後再請陳小姐再做一次下犬式的動作。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">神奇的事發生了</span><span lang="EN-US">!! </span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左手手肘緊緊的感覺就立刻消失了。</span><span lang="EN-US"><o:p></o:p></span></b></span></div>
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<span style="font-size: large;"><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但是</span><span lang="EN-US">……</span></b><b><span style="color: red; font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左手手肘疼痛與右邊臀部的控制差</span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為什麼會有關係呢</span><span lang="EN-US">?!<o:p></o:p></span></b></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這個似乎很難串起來,但其實從動力鍊的角度去看都是有跡可循的。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">打高爾夫球時,陳小姐打球的方式是左手持桿,揮桿時腰是向左旋轉的,<b>從上桿的頂點到下桿的轉換動作時,是<span style="color: red;">重心從右邊轉移到左邊</span>的關鍵時刻,此時<span style="color: red;">右臀的控制</span>變得非常重要</b></span><b><span lang="EN-US">!</span></b><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如圖</span><span lang="EN-US">5</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span><span lang="EN-US">6)<o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuO6h4J3DlI3TfO5V-dOuZ-64xgw4mfABHM_eePF-NpUv_juZiRrRa_IbL7eaoy8xeo_xBT3ygZNdxfXwN7w99ExgbSz3njaTxecQ9fkT-IGrvoHnSxP6fGincRoZoH2QNoM_xq2APjZbN/s1600/5.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuO6h4J3DlI3TfO5V-dOuZ-64xgw4mfABHM_eePF-NpUv_juZiRrRa_IbL7eaoy8xeo_xBT3ygZNdxfXwN7w99ExgbSz3njaTxecQ9fkT-IGrvoHnSxP6fGincRoZoH2QNoM_xq2APjZbN/s320/5.png" width="320" /></span></a></div>
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<span style="font-size: large;"><span lang="EN-US"><!--[if gte vml 1]><v:shape
id="圖片_x0020_7" o:spid="_x0000_i1028" type="#_x0000_t75" style='width:338.25pt;
height:236.25pt;visibility:visible;mso-wrap-style:square'>
<v:imagedata src="file:///C:\Users\055D~1.ASU\AppData\Local\Temp\msohtmlclip1\01\clip_image010.png"
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<span style="font-size: large;"><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span><span lang="EN-US">5. </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片來源</span><span lang="EN-US">: <a href="https://goo.gl/2bMDcc" target="_blank"><span style="color: #ff8000; font-family: "Helvetica","sans-serif";">https://goo.gl/2bMDcc</span></a>)
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">橘色粗線代表重心大多在右腳</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuqO1JR244bWadSfdf4Fvotf5tihrrHzbwlCw0YJY3eY6BN9WVOECn-s-S5ZBJVLtEpFQi7iAD-gFGDvcrmiij3DZS0GFz9Pf-aDtaBCdb-WWVBF8g3IvBLAieOznlNLlfsNc2f-7a32X3/s1600/6.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuqO1JR244bWadSfdf4Fvotf5tihrrHzbwlCw0YJY3eY6BN9WVOECn-s-S5ZBJVLtEpFQi7iAD-gFGDvcrmiij3DZS0GFz9Pf-aDtaBCdb-WWVBF8g3IvBLAieOznlNLlfsNc2f-7a32X3/s320/6.png" width="320" /></span></a></div>
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<span style="font-size: large;"><span lang="EN-US"><!--[if gte vml 1]><v:shape
id="圖片_x0020_9" o:spid="_x0000_i1027" type="#_x0000_t75" style='width:336.75pt;
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<v:imagedata src="file:///C:\Users\055D~1.ASU\AppData\Local\Temp\msohtmlclip1\01\clip_image012.png"
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<span style="font-size: large;"><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span><span lang="EN-US">6. </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片來源</span><span lang="EN-US">: <a href="https://goo.gl/2bMDcc" target="_blank"><span style="color: #ff8000; font-family: "Helvetica","sans-serif";">https://goo.gl/2bMDcc</span></a>)
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">此時重心大多已轉移到左腳</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因為這個動作是帶動下桿時的肩膀與腰部向左轉動的擊球力量,而個案會因為<b>想要追求更大的擊球力量單純運用<span style="color: red;">左腰的扭力</span>,造成左腰常常不適。</b></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖</span><span lang="EN-US">7. </span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖片來源</span><span lang="EN-US">: <a href="https://goo.gl/2bMDcc" target="_blank"><span style="color: #ff8000; font-family: "Helvetica","sans-serif";">https://goo.gl/2bMDcc</span></a>)
</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">擊球結束</span><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">送桿</span><span lang="EN-US">)<o:p></o:p></span></span></div>
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</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">收桿</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當患者只接受局部</span><span lang="EN-US">(</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">左手手肘</span><span lang="EN-US">)</span><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的肌肉放鬆和肌力訓練是無法根治疼痛,若不改善這整個動力鍊的,反覆發作就是必然的結果啦</span><span lang="EN-US">~<o:p></o:p></span></span></div>
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<b><span style="font-size: large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">物理治療師是動作控制和訓練的專家,從造成疼痛的動作去<span style="color: red;">分析動力鍊才能找到問題的根源</span></span><span lang="EN-US">------</span></span></b><b><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;">讓你<span style="color: red;">脫離疼痛,繼續快樂運動</span></span></span><span lang="EN-US" style="color: red;"><span style="font-size: large;">!</span><o:p></o:p></span></b></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-40754191109910381672016-03-14T08:00:00.003-07:002016-03-14T08:01:11.851-07:00避免膝蓋開刀後遺症,物理治療很重要!!<div class="MsoNormal">
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<span style="color: orange; font-size: large;">作者:姚斯元 物理治療師</span></div>
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<a href="http://www.jhspt.com/"><span style="color: orange; font-size: large;">晉熯脊骨物理治療所</span></a></div>
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<a href="https://www.facebook.com/linphysiotherapy"><span style="color: orange; font-size: large;">臉書連結</span></a></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6T3xRFrTSKPrRgkcCT2dz_6NUtXcgsluE2CmsdqC32h8Xic_JHcb0YrCyrKGV-W_A3BWsFkd-qyZSWKIAR_E1WuEMYDy0qrACfE6EewLtDIvwQL8Ykh0uwl31qFxAQoeoGvGvZR9rETQ7/s1600/LP-PostOp.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="118" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6T3xRFrTSKPrRgkcCT2dz_6NUtXcgsluE2CmsdqC32h8Xic_JHcb0YrCyrKGV-W_A3BWsFkd-qyZSWKIAR_E1WuEMYDy0qrACfE6EewLtDIvwQL8Ykh0uwl31qFxAQoeoGvGvZR9rETQ7/s320/LP-PostOp.jpg" width="320" /></a></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">陳小姐是本治療所的長期病患,她在兩年前一次嚴重的車禍之後,<span style="color: orange;">接受了骨折的手術,但術後因為工作繁忙沒有接受完整的運動訓練,以致來到治療所時患部僵硬無力,而且動作很不靈活</span>。評估發現與膝蓋相關的<span style="color: orange;">股四頭肌,臀肌,都有嚴重的萎縮,並且關節沾黏十分嚴重,以致需要長時間的治療。</span>每次遇到這種病人,我都會感到十分的惋惜,因為在黃金期時如果他們有接受物理治療,就可避免後面的種種後遺症。而這些後遺症,可能要花上更多的時間跟金錢去診治</span><span lang="EN-US">!<o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一般在動過膝蓋手術後的第一天,若狀況許可,就可以開始進行床邊物理治療了。<span style="color: orange;">物理治療的目的在保持關節的活動度跟肌肉力量</span>。</span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWoEtK8y0zUUIahtF-CiXnxEXaFT6KnKPAi9Ch2Eaqne36RjDc0yVo-PWUwdYBLGB8dmHmibHHGXfv-ug25u8QpFRYSek4mg5QVgMa_e2FRV_u_ULFdZh4ePu3_lXmsSc8-ZnbtfU0glds/s1600/1448543714.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWoEtK8y0zUUIahtF-CiXnxEXaFT6KnKPAi9Ch2Eaqne36RjDc0yVo-PWUwdYBLGB8dmHmibHHGXfv-ug25u8QpFRYSek4mg5QVgMa_e2FRV_u_ULFdZh4ePu3_lXmsSc8-ZnbtfU0glds/s320/1448543714.jpg" width="320" /></a></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">人體是一個適應能力很強的系統,當關節與肌肉不動作不用力,身體就會以很快的速度把他們"除役"。只要一個禮拜沒有活動,肌肉就會開始萎縮,關節也會開始僵硬。<span style="color: orange;">所以術後能越早開始活動,就越能省去之後因為僵硬跟萎縮產生的後遺症。不過務必要在專業人員的指導下安全有效率的活動,並避免影響傷口癒合。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: x-large;"><br /></span></span></div>
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<span style="font-family: "新細明體","serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: xx-small;">膝蓋手術 術後復健 物理治療 腰痛 膝蓋痛 膝蓋開刀肌肉萎縮</span></span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-78391507958239591222016-02-03T05:48:00.002-08:002016-02-03T05:48:49.562-08:00腰酸背痛好不了 原來是骨盆控制出了問題...<div style="text-align: right;">
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<span style="color: orange; font-size: large;">作者:姚斯元 物理治療師</span></div>
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<a href="http://www.jhspt.com/"><span style="color: orange; font-size: large;">晉熯脊骨物理治療所</span></a></div>
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<a href="https://www.facebook.com/linphysiotherapy"><span style="color: orange; font-size: large;">臉書連結</span></a></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 動作評估是物理治療師最重要的一項技術。透過動作評估,治療師可以找到造成傷害的動作,並加以處理,而不是</span><span style="font-family: Calibri;">”</span><span style="font-family: SimSun;">追著症狀走</span><span style="font-family: Calibri;">”</span><span style="font-family: SimSun;">。常常病人都會在疼痛的地方試過各種不同的治療,但沒有改善。原因或許不是治療無效,而是地方不對。</span><span style="font-family: SimSun;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 林小姐是服務業的店長,因為</span><span style="color: orange;">工作需求一天需要站10到12小時,漸漸地,一天的工作之後,她常常會覺得腰部緊繃不舒服</span><span style="font-family: SimSun;"><span style="font-family: SimSun;"><span style="color: orange;">。</span>雖然去按摩放鬆會有短時間的改善,但是往往只能維持一到兩天,甚至有越來越嚴重的趨勢,於是在親友的介紹下來到治療所求診。</span></span></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWLs5frYADezSeEwz1jHutiVAt_EYH7sz0PAmLwy587qOj7cmCSCSZLHOvG4rtwX0ZS888_SudyqfrZW3aQjioqYX50YqXIsz3rLblJUaulZFixroQoCUPrAHtT5J0KZMBAX4gxh-Mxxzo/s1600/Back-Pain-Big.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWLs5frYADezSeEwz1jHutiVAt_EYH7sz0PAmLwy587qOj7cmCSCSZLHOvG4rtwX0ZS888_SudyqfrZW3aQjioqYX50YqXIsz3rLblJUaulZFixroQoCUPrAHtT5J0KZMBAX4gxh-Mxxzo/s320/Back-Pain-Big.jpg" width="320" /></a></span></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 在幫林小姐做觸診評估時發現,她的<span style="color: orange;">脊椎弧度非常的大,內凹的非常多,同時周圍的肌肉非常的緊繃</span>,於是站立時體重都集中在腰部的最後幾節,造成脊椎軟骨的壓力過大,造成疼痛。理論上,將腰部周圍做放鬆之後,腰椎的壓力解除,症狀一定會有好轉,我相信這也是她在按摩完會有好轉的原因。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 但<span style="color: orange;">脊椎不會無緣無故的內凹這麼多並且緊繃,一定有其他原因存在影響整體的動作,不然症狀在按摩完就應該要消失了</span>。</span><span style="font-family: SimSun;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 接下來,在做動作評估的時候,我發現林小姐的骨盆控制非常的不好,<span style="color: orange;">站立時骨盆會向前傾,相對的帶動脊椎的位置不正常,導致脊椎的弧度過大。</span></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj76-faM1D_V8nUJpO4CTkkAoa5nMt0dwxlc9XEfjJxWBYKOyCkSOWSxltUhDgcSamdDio6uJfutrascIuPvDjakbgCeUNNEPKnj4uAsZHDZUeMgdm9_P8vtPlb7Sg2tv2TaEBWmDByNadj/s1600/LordosisWMv1JPG.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj76-faM1D_V8nUJpO4CTkkAoa5nMt0dwxlc9XEfjJxWBYKOyCkSOWSxltUhDgcSamdDio6uJfutrascIuPvDjakbgCeUNNEPKnj4uAsZHDZUeMgdm9_P8vtPlb7Sg2tv2TaEBWmDByNadj/s320/LordosisWMv1JPG.jpg" width="320" /></a></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 既然骨盆是問題的根源,處理骨盆的控制自然就是治療的重點。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: SimSun;"> 在放鬆了林小姐骨盆前方的</span><span style="color: orange;">髂脛束(IT band),同時訓練臀肌,讓骨盆不會再前傾。做完治療之後她就覺得腰挺得比較直了</span>,後續追蹤也覺得症狀有長足的改善,甚至他還覺得<span style="color: orange;">儀態也更加的好了(意外收穫!)。</span></span><br /><br /> </div>
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<span style="font-family: SimSun;"><span style="font-size: x-large;"> 透過動作評估,物理治療可以幫助病人得到長久性的療效,<span style="color: orange;">徹底的根治肌肉骨骼系統的不舒服。</span></span></span><span style="font-family: 'SimSun'; font-size: 11.0000pt; mso-spacerun: 'yes';"><o:p></o:p></span></div>
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<span style="color: #444444; font-family: SimSun; font-size: xx-small;">動作分析 動作控制 骨盆歪斜 腰酸背痛</span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-79719955684045259292016-01-19T06:30:00.002-08:002016-01-21T02:52:35.583-08:00跌倒後的長期膝蓋痛,問題竟是出在脊椎!!<div style="text-align: right;">
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<span style="color: orange; font-size: x-large;">作者:林晉熯 院長</span></div>
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<a href="http://www.jhspt.com/"><span style="color: orange; font-size: x-large;">晉熯脊骨物理治療所</span></a></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">最近一位從英國放假回來的客戶,因為一年前打籃球跌倒撞傷,<span style="color: orange;">左邊膝蓋就常隱隱作痛</span>,尤其是跑步或走路約</span><span style="font-family: 標楷體;">30分鐘左右</span><span style="font-family: 標楷體;">,疼痛感就變得極為明顯;另外,在坐的時候,<span style="color: orange;">無法將左邊膝蓋完全伸直</span>,而且一伸直就會一直發抖,而右膝則是正常的可以穩定的伸直。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">當時<span style="color: orange;">診斷是後十字韌帶受傷</span>,他就做了很多復健運動,肌力訓練、核心訓練</span><span style="font-family: 標楷體;">...等等,都不見效果。受傷後也將近一年,他不敢也無法盡情打籃球,常常活動一段時間就開始隱隱作痛,不勝困擾許久。經朋友介紹來我們治療所求診。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">因為在英國時的診斷是後十字韌帶受傷,於是我開始進行一系列的理學評估,包括膝蓋的肌力測試、穩定度測試等,發現兩腳都很正常。我就想<span style="color: orange;">若真的是十字韌帶的問題,理論上作了那麼久的復健運動,也該要有好轉的趨勢才是,但是他並沒有。所以我懷疑此「案情」沒那麼單純!</span></span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">我便為他做個脊骨暨肌筋膜整體評估,發現他動作失能最大的是在:</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">1. <span style="color: orange;">坐姿下身體向左旋轉角度偏小</span>,約只有30度;</span><span style="font-family: 標楷體;"><br /></span><span style="font-family: 標楷體;"> 2. 坐姿下<span style="color: orange;">左腳無法完全伸直</span>。</span><span style="font-family: 標楷體;"><br /></span><span style="font-family: 標楷體;"> 3. <span style="color: orange;">單腳跳躍測試時,左腳有極輕微的有感痠痛</span>(疼痛指數不到1分)。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">經治療性測試後發現,<span style="color: orange;">最主要的問題根源來自於左側第五節腰椎(L5)錯位</span>,因其測試可使身體旋轉角度明顯增加。另外,他的狀況也<span style="color: orange;">合併有左側薦髂關節錯位(SI dysfunction)以及背側肌筋膜鏈緊繃。</span></span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">在調整完左側腰椎第五節(L5)、薦髂關節(SI joint)和放鬆肌筋膜(Myofascia release)後,客戶反映他的下半身與剛來的時候相比,輕了非常多,而且膝蓋伸直就完全沒問題了。同時,單腳跳躍測試也完全沒有了酸痛感。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">此個案因跌倒後長期膝蓋痛的主因是來自於<span style="color: orange;">打籃球當下碰撞跌倒,強烈的衝擊力,間接使腰椎骨盆錯位,影響下肢的神經肌肉控制,疼痛感就反映在當初受傷的位置,但腰部卻沒有任何不適感。</span></span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">也許你會好奇為什麼平常不痛? <span style="color: orange;">要運動一段時間後才會痛,而不是一直痛呢?</span> 既然是腰的問題,怎麼不會腰痠卻是膝蓋痛呢? </span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">其實這與<span style="color: orange;">身體整體平衡代償</span>有關,當活動量不大的時候,身體還有足夠的能力去代償,但是超過一定量的時候,<span style="color: orange;">身體無法再維持平衡,肌肉、筋膜或關節也無法再承受那異常的負荷,症狀就會出現,只是症狀產生的地方不一定。</span>可能會在之前受傷的位置,也可能在你意想不到的地方,這都需要<span style="color: orange;">經物理治療師整體評估測試後,才能找出症狀癥結真正的根源點。</span></span></span><span style="font-family: "標楷體"; font-size: 14.0000pt;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-6046689735617836302016-01-07T06:10:00.004-08:002016-01-07T22:18:55.935-08:00頸因性頭痛:不明原因的的頭痛,可能與頸椎病有關!!<div class="p0" style="margin-bottom: 0pt; margin-top: 0pt; text-align: right;">
<span style="color: orange; font-size: x-large;">作者:姚斯元 物理治療師</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIGLFQT3N5htIPUJDeivDjtIAkhPAslHSAz4HVkwLxMgLv5smUaQtFd2wJ7FFKat2zRb24Sc-RomfUBqGdI2BMXAlT3YvZ3cgENXZPxDugSdJwGThTYSJc2vNEJN04pZ3ka7zU4UF0xcM3/s1600/545137-4786-36.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIGLFQT3N5htIPUJDeivDjtIAkhPAslHSAz4HVkwLxMgLv5smUaQtFd2wJ7FFKat2zRb24Sc-RomfUBqGdI2BMXAlT3YvZ3cgENXZPxDugSdJwGThTYSJc2vNEJN04pZ3ka7zU4UF0xcM3/s1600/545137-4786-36.jpg" /></a><span style="font-size: x-large;"><br /> 現代生活的人們壓力大,又多半睡眠不足,以致多數人有著頭痛的困擾,甚至有許多人需要長期吃藥控制。造成頭痛的原因有很多,壓力、血壓、血糖、睡眠品質都是影響的原因。但是,<span style="color: orange;">頸椎病變也會造成頭痛,臨床上稱之為頸因性頭痛。根據統計,每五個頭痛的人就有一個來自於頸因性頭痛。</span><br /><br /> 頸因性頭痛的症狀常與偏頭痛相近,包含<span style="color: orange;">單邊的頭部、眼窩、前額疼痛,有時候也會伴隨著肩頸痠痛,甚至是下巴顳顎關節的疼痛。</span>嚴重時甚至有噁心、頭暈、畏光、視力模糊等現象。<span style="color: orange;">當我們因為平常姿勢的不良或是外傷造成第一、第二節頸椎位置的偏移,上頸椎的疼痛訊號經由三叉神經核傳遞到臉或頭部時,就很容易產生在頭部的轉移疼痛,造成頭痛。</span></span></div>
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<span style="font-size: x-large;"><br /> 有些頭痛,用藥物控制效果不彰,就有可能是頸因性頭痛。但我們要如何知道自己是否是頸因性頭痛呢? <span style="color: orange;">既然頸因性頭痛的病源是來自頸椎錯位,當頸椎移動時,自然就會牽連到錯位的地方,造成頭痛症狀的產生。</span></span></div>
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<span style="font-size: x-large;">所以我建議頭痛的人可以用以下的這三個動作自我測試。<br /><br /><span style="color: orange;"><b>1. 頭部往前延伸,眼睛要保持直視前方</b></span></span></div>
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<span style="font-size: x-large;"><br /><br /><b><span style="color: orange;">2. 保持頭部延伸的同時,頭部往左右旋轉到底。</span></b></span><br />
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<br /><span style="color: orange;"><b>3. 保持頭部延伸的同時,往左右輕輕點頭</b></span><div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtfSdMPYQzEcv6OI2f-I4qhYslfq93nG9zuefM_Ck3h5oe4kX4lT2zxSIqqRSULalT46spcxPHKaKMuxIGHvFOzOOj0f-0bJ_OczPZwr5U4HDYrDZDsloPCS6hMxXjAu9vl_O6i8fUfmG2/s1600/IMGP6477.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtfSdMPYQzEcv6OI2f-I4qhYslfq93nG9zuefM_Ck3h5oe4kX4lT2zxSIqqRSULalT46spcxPHKaKMuxIGHvFOzOOj0f-0bJ_OczPZwr5U4HDYrDZDsloPCS6hMxXjAu9vl_O6i8fUfmG2/s320/IMGP6477.JPG" width="320" /></a></div>
<br /><br /> 這三個動作都會將第一第二節的頸椎活動到極限,而如果當你做這三個動作的同時觸發了頭痛的症狀,或是頭痛變得更加嚴重。那你可能需要尋找物理治療師做更進一步,全身完整的檢查。<br /><br /> 多項研究結果都得出,在施作<span style="color: orange;">調整脊椎,頸椎鬆動術,肌筋膜放鬆,頸椎肌肉運動之後,頸因性頭痛的症狀可以獲得顯著的改善。</span><div class="separator" style="clear: both; text-align: center;">
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<br /><br /> 頸因性頭痛跟牙痛一樣,雖不會有生命危險,但卻會嚴重的影響生活品質,而有一定比例的頭痛案例病因是來自頸椎的移位,而<span style="color: orange;">透過物理治療可以有效地降低症狀,改善生活品質。</span></span><br />
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<span style="font-size: xx-small;">頸因性頭痛 頸椎病 肩頸痠痛 張力型頭痛 晉漢 物理治療 偏頭痛 顳顎關節痛 下巴痛 眼眶痛</span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-8453592545917063452015-12-15T01:26:00.002-08:002015-12-15T01:31:56.017-08:00為什麼肩頸痠痛,按摩卻好不了 <div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: x-large;">作者:姚斯元 物理治療師</span></div>
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<a href="http://www.jhspt.com/" target="_blank"><span style="color: orange; font-size: large;">晉熯脊骨物理治療所</span></a></div>
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<span style="font-size: x-large;"> 肩頸痠痛時,很多人第一時間的處理就是在酸痛的地方按摩,但常會發現,雖然按的時候很舒服,效果卻不持久,舒服一兩天又開始痛了。為什麼會這樣呢? 通常都是沒有作整體的姿勢評估,找出真正的原因造成。</span><br />
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<span style="font-size: x-large;"> 黃小姐因為工作需要長時間低頭寫東西,所以造成了後頸和肩膀痠痛。她形容那感覺像是肩頸隨時隨地都重重的,沒有輕鬆感覺過。評估之後,<span style="color: orange;">發現她的疼痛主因是提肩胛肌(levator scapulae muscle)的緊繃</span>。提肩胛肌是一條從肩胛骨連接到頸椎的肌肉,當這條肌肉緊繃時,會增加頸椎的壓力,造成肩頸的酸痛。而黃小姐的肩胛骨有前移的現象,使得提肩胛肌被拉長,才會有緊繃的現象。再針對這麼現象深入的評估後,我發現她的<span style="color: orange;">前鋸肌(Serratus anterior muscle)跟胸小肌(pectoralis minor muscle )都非常的緊繃,才會把肩胛骨往前方拉,造成駝背,導致提肩胛肌緊繃不舒服。</span></span><br />
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<br /><br /> 解剖列車(anatomy train)中曾提到,<span style="color: orange;">當人體的旋線(Spiral Line)過緊時,肩胛骨常會被拉向身體前方,造成不良的姿勢</span>。而前鋸肌,正是旋線中非常重要的一條肌肉。肩胛前移之後,則會造成胸小肌的縮短。縮短的胸小肌又會加重駝背的現象,於是不停的惡性循換,駝背越來越嚴重。長年下來,則會衍生出許多的肩頸痠痛疾病,黃小姐的提肩胛肌緊繃就是常見的現象之一。<div class="separator" style="clear: both; text-align: center;">
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<br /><br /> 黃小姐不但接受了提肩胛肌的放鬆,另外兩條造成她姿勢不良的肌肉也得到了徒手治療的處理,做完之後她感覺可以輕鬆的挺起胸,症狀也不會一兩天就回到之前的狀態。<span style="color: orange;">因為提肩胛肌的緊繃只是一連串姿勢代償所造成的結果</span>,如果不就本來造成姿勢緊繃的肌肉去處理,而只在酸痛的提肩胛肌上按摩的話,雖然肌肉放鬆的瞬間,會感覺很輕鬆,很舒服。但不久後肌肉會再度地回到緊繃的狀態,病人自然就會感覺症狀又回來了。當然,長年肌張力不平衡也會造成肌肉的無力,所以後續還要再接受肌力的訓練,才能有更長久的療效。<br /><br /> 人體的肌肉是一個整體的系統,常常都會互相幫忙配合。也是因為這樣,常常出問題時會有連鎖反應,這也是完整全身評估這麼重要的原因。</span><br />
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<span style="color: #444444; font-size: xx-small;">肩頸痠痛 解剖列車 慢性痠痛 姿勢不良 脖子痛</span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-48736211301795270602015-12-03T06:30:00.000-08:002015-12-21T21:08:26.994-08:00手痠麻的問題竟是在腰部?!(案例分享)<div style="text-align: left;">
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<span style="font-size: x-large;">作者:林晉熯 院長</span><br />
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<span style="color: orange; font-size: large;"><a href="https://www.facebook.com/linphysiotherapy">晉熯脊骨物理治療所</a></span></div>
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<a href="http://www.jhspt.com/" style="font-size: x-large;">http://www.jhspt.com</a><br />
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<span style="font-family: "新細明體-extb"; font-size: 14.0000pt; mso-spacerun: 'yes';"> </span><span style="font-family: inherit; font-size: x-large;">臨床上常會遇到各種肩頸痠痛或是上肢痠麻痛的個案來求診,然而肩頸或上肢痠麻的問題,有些問題的根源卻不一定都是來自頸椎出了問題…<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">示意圖</td></tr>
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<span style="font-family: inherit; font-size: x-large;"> 一位經醫師診斷<span style="color: orange;">頸椎C6/7長骨刺退化</span>,而產生<span style="color: orange;">右手痠麻痛</span>的家庭主婦,因為近期症狀加劇前來求診。這位個案非常喜歡看書,低頭的時間常一天高達2-3小時。</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXzmRCStQyEzb6fxBKPWrjUkFTgO-4AXnVC2RVjZD6HaN2HONjXH59jXf_MB0Q7Aa9Da5wSvtXs2Wut1Sh0lmh7SM1tPdObnonDqBcNfm1JW8q16DaofAUWbWkdvUO0qBfbZ7PQHt6bMmS/s1600/C67+spur.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXzmRCStQyEzb6fxBKPWrjUkFTgO-4AXnVC2RVjZD6HaN2HONjXH59jXf_MB0Q7Aa9Da5wSvtXs2Wut1Sh0lmh7SM1tPdObnonDqBcNfm1JW8q16DaofAUWbWkdvUO0qBfbZ7PQHt6bMmS/s320/C67+spur.png" width="227" /></a></div>
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<span style="font-family: inherit; font-size: x-large;">肩頸也理所當然地十分僵硬,而<span style="color: orange;">右手痠麻的發生則不一定,有時麻有時不麻,不會因為某些特定動作發生,有時麻個十幾分鐘會自己退掉,有時就麻個一整天。</span><o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 我為她做了整體評估和動作檢測後發現…<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;">1. 脖子右轉角度約45度,就有緊繃的感覺。<br />2. 坐姿下軀幹向右旋轉明顯受限,大約只有15度。<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 在肩頸上以及右側頸椎C5~C7上皆有明顯壓痛點,身體其他多處亦有明顯壓痛點。</span></div>
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<span style="font-family: inherit; font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhli9Pa8wUVOzkfitBei-F1g4GVKPXMz88m3_Ya1BqNYL60AFNV9ztZQx_mlD0yn80vddUGNIeBsO900TH2U_cBbTBWRtUS9hyphenhyphen0RRdB0k4A8lE3J0OIRsU6QcuJI2TppMabJMK1YkE4ERq0/s1600/78d6eb4864c94880f124f6b4d5c3cd65.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhli9Pa8wUVOzkfitBei-F1g4GVKPXMz88m3_Ya1BqNYL60AFNV9ztZQx_mlD0yn80vddUGNIeBsO900TH2U_cBbTBWRtUS9hyphenhyphen0RRdB0k4A8lE3J0OIRsU6QcuJI2TppMabJMK1YkE4ERq0/s320/78d6eb4864c94880f124f6b4d5c3cd65.jpg" width="320" /></a></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 而我在<span style="color: orange;">直接做頸椎治療性測試時發現<b><u>無法</u></b>讓脖子和軀幹旋轉角度改善</span>,於是我想事情不會那麼簡單。<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 在客觀的觸診評估檢查後,發現在對<span style="color: orange;"><b><u>右側L5/S1</u></b>的位置做動態關節鬆動術測試時可以讓脖子變鬆,身體旋轉角度明顯增加。</span></span></div>
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<span style="font-family: inherit; font-size: x-large;"><span style="color: orange;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB5ORNZBZYja0G63sg_lRQNsFCkP-3dR71SmuL8X8Uxe_p9V0K9d6Qw5vukzbZrs-8HHBsHTPH6Vqv7ou5Z8mYhahjoZhnJxCKgOgqtM79x1Pxv0AN0zqdkZTSwVpk7jeZDt6fRPs3pFHF/s1600/images.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB5ORNZBZYja0G63sg_lRQNsFCkP-3dR71SmuL8X8Uxe_p9V0K9d6Qw5vukzbZrs-8HHBsHTPH6Vqv7ou5Z8mYhahjoZhnJxCKgOgqtM79x1Pxv0AN0zqdkZTSwVpk7jeZDt6fRPs3pFHF/s1600/images.jpg" /></a></span></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 我想就是這個地方了,於是在該處直接做筋膜放鬆術和關節鬆動後,客戶直接反應就是覺得肩頸都鬆開了。<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 隔週的回診也反映良好,表示那種莫名痠麻的感覺少很多了,甚至感覺不到有痠麻症狀。總共治療個三次,觀察一個月後,反應良好,似乎痠麻就沒有再犯了!!<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 依照檢查直觀認知,大多一定會認為就是頸椎神經壓迫導致手麻的。但回歸根源點的概念,<span style="color: orange;">筋骨的病痛勢必會讓動作控制產生限制或誘發症狀</span>,若我們找的地方並不是產生症狀的根源,就算在<span style="color: orange;">影像學檢查該處有明顯病理或結構變化,即使這是個很重要的檢查參考,也不代表一定就是可以解決症狀問題的關鍵。</span><o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"> 但是<span style="color: orange;">為什麼治療腰椎可以改善他的上肢痠麻</span>呢?? 這似乎沒有直接關係啊??</span></div>
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<span style="font-family: inherit; font-size: x-large;"> 根據筋膜動力學理論,人體是被一層層筋膜包覆,彼此互相影響,人體的受力和筋膜張力也會彼此交互作用。</span></div>
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<span style="font-family: inherit; font-size: x-large;"> 於<span style="color: orange;">解剖列車(Anatomy train)中淺背線(Back line)的筋膜走向</span>,其張力影響會上下傳遞,正好也符合這位個案的解釋。可能他長時間坐著看書,姿勢也不是很正確,讓<span style="color: orange;">下腰筋膜繃緊牽扯,使得頸部筋膜太緊導致頸部神經受刺激</span>,產生上肢痠麻。<o:p></o:p></span></div>
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<span style="font-family: inherit; font-size: x-large;"><span style="color: orange;">症狀的根源點有時會出現在我們所意想不到的地方</span>,只有仔細評估檢查才不會漏掉任何蛛絲馬跡,來達到最佳治療效果。</span><span style="font-family: "新細明體-extb"; font-size: 14.0000pt; mso-spacerun: 'yes';"><o:p></o:p></span></div>
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<span style="color: #444444;">根源點 Ridgway method 頸椎退化 手麻 手痠麻 腰痛 脖子痛 解剖列車 淺背線 整脊 </span></div>
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<span style="color: #444444;">手麻怎麼辦 手麻治療推薦 手麻就是脖子的問題嗎 上肢痠麻怎麼辦</span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-39709327512281433982015-11-05T06:04:00.000-08:002015-12-21T21:03:22.706-08:00腰痛好了,怎麼換膝蓋痛??<div class="p0" style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="font-size: x-large;"><span style="font-family: "simsun";">作者:<b>姚斯元</b> 物理治療師</span></span></div>
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<span style="font-size: large;"><span style="font-family: "simsun";"><span style="font-size: x-large;"> </span><a href="http://www.jhspt.com/" target="_blank"><span style="color: orange;">晉熯脊骨物理治療所</span></a><span style="color: orange;"><br /><a href="http://www.jhspt.com/">http://www.jhspt.com</a></span></span></span><br />
<span style="font-size: large;"><span style="color: orange; font-family: "simsun";"><a href="https://www.facebook.com/linphysiotherapy">https://www.facebook.com/linphysiotherapy</a></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "simsun";"> 在臨床上,當病人的症狀已經好了七八成之後,我常會讓病人開始接受<span style="color: orange;">運動復健療程</span>。雖然<span style="color: orange;">重新建立<b>神經對肌肉的控制</b></span>是個非常辛苦</span></span></div>
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<span style="font-size: x-large;">的過程,但是,這一切都是為了能有長久的療效,把完整的療程做完,<span style="color: orange;">對於後遺症的預防非常有幫助。</span><span style="font-family: "calibri";"><o:p></o:p></span></span><br />
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<span style="font-size: x-large;"><span style="font-family: "simsun";"> 廖先生是因為膝蓋的不舒服來到治療所諮詢,他曾在<span style="color: orange;">不久之前閃到了腰,之後腰跟腳一直都有痠麻的症狀。但他並沒有特別去做治療及復健,而只是多休息</span>。雖然本來腳的痠麻在休養之後漸漸的好轉</span></span></div>
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<span style="font-size: x-large;">了,但卻在<span style="color: orange;">一個禮拜前<b><u>膝蓋前方出現疼痛</u></b>的現象</span>,走路上下樓梯都異常疼痛,他覺得是坐骨神經的症狀又發作了,於是來尋求物理治療。<span style="font-family: "calibri";"><o:p></o:p></span></span><br />
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<span style="font-size: x-large;"><span style="font-family: "simsun";"> 經過評估之後,我發現廖先生的膝蓋症狀並不是腰部的轉移痛,而是<span style="color: orange;"><b><u>局部的髕骨軟化症</u></b></span>。但是他的核心肌群極為無力,導致他的上下樓梯跟走路的姿勢都出現了歪斜的現象。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "simsun";">所以可以推斷,他是因為<span style="color: orange;">過去的腰痛導致核心肌群無力,<b>神經肌肉控制失調,進而讓姿勢產生改變</b></span>,給了膝蓋過多的壓力,導致膝蓋受傷。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "simsun";">於是,在兩次局部肌筋膜放鬆</span><span style="font-family: "simsun";">,以及<span style="color: orange;"><u><b>臀中肌的訓練</b></u></span>之後,他已經感覺到<span style="color: orange;">膝蓋不再疼痛</span>了。</span><span style="font-family: "calibri";"><o:p></o:p></span></span></div>
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<span style="font-family: "simsun";"><span style="font-size: x-large;"> 復健的療程不是症狀消失就結束了,身為醫療人員,病患能得到長久的健康也是我們非常關心的。<span style="color: orange;">整體的核心跟姿勢調整能讓物理治療的效果更加的延長,而不會腰痛完痛脖子,脖子痛完痛膝蓋,永遠沒有終止的一天</span>。</span></span><span style="font-family: "calibri"; font-size: 12.0000pt; mso-spacerun: 'yes';"><o:p></o:p></span></div>
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<span style="font-family: "simsun"; font-size: xx-small;">髕股骨軟化症 PFPS 膝蓋痛怎麼辦 腰酸背痛 坐骨神經痛怎辦 臀中肌訓練 redcord Neurac</span></div>
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<span style="font-family: "simsun"; font-size: xx-small;">姿勢不良 上下樓梯膝蓋痛</span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-38181855869895417052015-10-19T07:10:00.004-07:002015-12-21T21:03:32.662-08:00肌肉拉傷好不了,到底問題出在哪?<div class="MsoNormal">
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<span style="font-size: large;">作者:姚斯元 物理治療師</span></div>
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<span style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank"><span style="color: orange;">晉熯脊骨物理治療所</span></a></span></div>
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<span style="font-size: large;"><span style="color: orange; font-family: "新細明體" , "serif"; font-size: medium; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><a href="http://www.jhspt.com/">http://www.jhspt.com</a></span></span></div>
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<span style="color: orange; font-family: , serif; font-size: large;"><a href="http://www.facebook.com/linphysiotherapy">http://www.facebook.com/linphysiotherapy</a></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> <span style="color: orange;">肌肉拉傷</span>是常見的運動傷害,一般人常認為拉傷只是</span><span lang="EN-US">”</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">輕微</span><span lang="EN-US">”</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的傷害,休息和冰敷之後自然就會好。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 蕭先生是一個籃球的愛好者,他每周日都有固定的籃球比賽,一次都是一到兩個小時左右。<span style="color: orange;">而在一次籃球比賽之後,他感覺到右前側膝蓋的不適,甚至難以步行。</span></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在<span style="color: orange;">休息了一到兩周之後,他覺得膝蓋似乎好了一些,就開始慢跑調整體力,誰知道跑完之後症狀全部回來了</span>,於是決定接受自費的<span style="color: orange;">物理治療</span>,好好根治問題。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">經過問診與理學檢查之後,發現他的<span style="color: orange;">股四頭肌肌腱已經拉傷,發炎,同時右側的臀大肌</span></span><span style="color: orange;"><span lang="EN-US">(gluteus maximus)</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">十分的無力。</span></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在徒手治療,並再使用</span><span lang="EN-US">Redcord</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">紅繩系統訓練臀大肌之後,他感覺症狀好了很多。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第二次的復健之後,在週末的籃球比賽上場了一個小時,症狀也沒有再復發了。</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUGUPX-ALwtRtYmtrXlnSaNuF3tts2_JlLip4KwwfQTgdbeYlVuydo6ptij9fL2Qx2D5Nvth1GJc0iq9UadlmZErwt7xI31I6ccVAEwHTqGgrit5fMkXSSFgNBEyG1-H6lwzxBwUXEK1od/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUGUPX-ALwtRtYmtrXlnSaNuF3tts2_JlLip4KwwfQTgdbeYlVuydo6ptij9fL2Qx2D5Nvth1GJc0iq9UadlmZErwt7xI31I6ccVAEwHTqGgrit5fMkXSSFgNBEyG1-H6lwzxBwUXEK1od/s1600/images.jpg" /></a></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> <span style="color: orange;">為何臀大肌無力會造成四頭肌的受傷呢</span></span><span lang="EN-US" style="color: orange;">?</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因為在起跳的動作時,<span style="color: orange;">四頭肌必須要跟臀肌一起收縮,產生往上的爆發力。</span></span></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMTccv0hDIF1tXc2RFjMTqJGrIjgAQvquZNodyD5Enp4DlwJFrisCcTyC-bErNCA8Kf0SSafIEWkZSlBHxxzHNPYB1FG6fdAPrtnO_LJ6B92SMy_gMDPeIUlBUMSdyf4KoLWwqa2MDRNCZ/s1600/E6307_507986_ebook_Main.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="299" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMTccv0hDIF1tXc2RFjMTqJGrIjgAQvquZNodyD5Enp4DlwJFrisCcTyC-bErNCA8Kf0SSafIEWkZSlBHxxzHNPYB1FG6fdAPrtnO_LJ6B92SMy_gMDPeIUlBUMSdyf4KoLWwqa2MDRNCZ/s320/E6307_507986_ebook_Main.jpg" width="320" /></a></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">落地時,兩個肌肉也要一起工作來緩衝身體的衝力。於是,<span style="color: orange;">當臀大肌無力的時候,股四頭肌就必須要超負荷的工作,最終造成受傷。</span></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">相反的,當接受臀大肌訓練之後,股四頭肌可以獲得妥善的休息,肌腱的拉傷自然就可以得到修復的時間,並且在運動時也不會再復發了。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">看似簡單的拉傷,其實處理起來一點也不簡單,全身的動作評估,<span style="color: orange;">找出問題根源點</span>,才是物理治療能根治病痛的不二法門。</span></span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></span>
<span style="font-size: x-large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></span>
<span style="font-family: "新細明體" , "serif"; font-size: xx-small; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">股四頭肌拉傷 肌肉拉傷發炎怎麼治療 肌肉拉傷 物理治療 運動傷害 核心訓練 redcord訓練 redcord治療 徒手治療 根源點治療</span><br />
<span style="font-family: "新細明體" , "serif"; font-size: xx-small; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">晉熯脊骨物理治療所 跑步膝蓋痛 打籃球膝蓋痛 </span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-44648165956677521322015-10-15T07:18:00.001-07:002015-12-03T07:26:03.729-08:00不是網球肘的網球肘(案例分享)<div style="text-align: right;">
<span style="font-size: large;">作者:林晉熯 院長</span></div>
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<span style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank">晉熯脊骨物理治療所</a></span></div>
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<span style="font-size: x-large;"> 一位<span style="color: orange;">長年左手肘關節疼痛的婦女</span>,疼痛感都是偶爾發生,被診斷為<span style="color: orange;">網球肘</span>,但是最近這幾個月症狀加劇。拿鍋子時,<span style="color: orange;">疼痛感會由肘關節往下傳到手腕上緣,並且會痛到無力,休息時的疼痛感也依舊存在。</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgx-jpPMMG-9kutyQSXpXmhf6VECUObZ2SgkbLzN_ZyS8_mhHixmxYPr_K05hX6UFsmGgQmC12nhU4-6M9VuMwoqXcHFODVSHb9gavRdjz5tUdvtq2g1bhIFNxZj50XexuhituJkKIxNsYM/s1600/12096150_920205991389741_6558442132981152133_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgx-jpPMMG-9kutyQSXpXmhf6VECUObZ2SgkbLzN_ZyS8_mhHixmxYPr_K05hX6UFsmGgQmC12nhU4-6M9VuMwoqXcHFODVSHb9gavRdjz5tUdvtq2g1bhIFNxZj50XexuhituJkKIxNsYM/s1600/12096150_920205991389741_6558442132981152133_n.jpg" /></a></div>
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<span style="font-size: x-large;"><br /> 於是我開始給他作一連串的動作測試,發現...</span></div>
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<span style="font-size: x-large;"> 1. 左手肘用力時(阻抗測試)明顯產生疼痛,但是被動伸展時則沒有症狀<br /> 2. 脖子向左轉時是輕微受限的,角度約45度<br /> 3. 軀幹右轉時明顯功能受限,角度約20度<br /> 4. 觸診時發現<span style="color: orange;">肘關節無明顯痛點</span><br /> 5. <span style="color: orange;">左側頸椎和肩膀有多處痛點</span><br /><br /> 我懷疑這位婦女的長年手肘痛不是單純的網球肘,於是再作個頸椎舒壓測試,發現可使手肘疼痛明顯減緩。<span style="color: orange;">觸診時也發現明顯有激痛點的地方是在左側頸椎第五節處的肌肉處。</span><br /><br /> 依神經學鑑別評估測試後,<span style="color: orange;">判斷手肘疼痛的問題可能是來自頸部神經受壓迫所致。<br /> 但若左側頸椎(C5)是症狀的根源點的話,理論上要可以有效改善功能性角度才是。</span></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjht3wlk-_9a0XRTRoIl7gjTeIjTu6hfBBdSim9R69RAMKiOrpmj07s4k9uDy7jWoDL-Cs4VjY-dNSXdurIvQWvUnBWvyFoAKJ9SsP2zgSmlOltnjNMmNaihyphenhyphenOg9azPGvpGjwLG5BG_Nte7/s1600/4674-0550x0475.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjht3wlk-_9a0XRTRoIl7gjTeIjTu6hfBBdSim9R69RAMKiOrpmj07s4k9uDy7jWoDL-Cs4VjY-dNSXdurIvQWvUnBWvyFoAKJ9SsP2zgSmlOltnjNMmNaihyphenhyphenOg9azPGvpGjwLG5BG_Nte7/s320/4674-0550x0475.jpg" width="276" /></a></span></div>
<span style="font-size: x-large;"><br /> 我在治療性測試時發現,對這位婦女的<span style="color: orange;">左側棘下肌(infraspinatus m.)按壓刺激,反倒比左側頸椎在功能性角度恢復上來的大。</span><br />有趣的是,我在直接治療棘下肌後,手肘的疼痛確實也比一開始測試時治療頸椎時的效果來的更好~~在當下。</span><span style="font-size: x-large;"><span style="color: orange;">疼痛感就立即改善六七成。</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKa8vjO2WMFo5oPSXmNVpttoiLN7DGJE8siN38MZheL09cksk0-Hd6gxleYhf9hqKtXqtVpT-lRjTznU2LrFmMukvIRo_r0J__BE4IInm4P77iZ4EFp_aAs-blI0_iOtG052ZpYWqQlaQi/s1600/12088384_920205994723074_6155195435248383375_n.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKa8vjO2WMFo5oPSXmNVpttoiLN7DGJE8siN38MZheL09cksk0-Hd6gxleYhf9hqKtXqtVpT-lRjTznU2LrFmMukvIRo_r0J__BE4IInm4P77iZ4EFp_aAs-blI0_iOtG052ZpYWqQlaQi/s1600/12088384_920205994723074_6155195435248383375_n.png" /></a></div>
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<span style="font-size: x-large;"><br /> 或許有人會問,為何頸椎不是最主要的問題呢?? 因為神經學檢測已經很明顯了! 不是嗎??<br /> 我也相信頸椎是一定有問題的,只是在我的評估下的結果,我會將它放在治療的第二順位。最主要的還是先處理棘下肌,因為<span style="color: orange;">對這位患者而言,治療棘下肌的效果不僅使症狀下降,更使功能明顯改善。</span><br /><br /> 會導致這樣的結果,有可能是患者長期的姿勢不良,用力不當,背包包又習慣左側背,使<span style="color: orange;">左側肩膀僵硬,筋膜變緊,間接是頸部肌肉也變緊,頸椎錯位,使神經受壓迫,產生神經轉移痛,使疼痛發生在手肘。</span><br /><br /> <span style="color: orange;">同一種症狀,不同的人發生,症狀的根源點可能不盡相同</span>,為了不被大腦的疼痛訊號所騙,只能客觀的評估測試找出來。</span></div>
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根源點 網球肘 手肘痛 頸椎錯位 肩膀痛 棘下肌 姿勢不良 筋膜放鬆 整脊 網球肘怎麼治療 根源點治療 CKT療法 根源點療法 網球肘怎麼辦 手肘痛怎麼辦 手臂痛怎麼辦 網球肘怎麼都不會好<br />
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-38006973261427987532015-09-27T02:01:00.002-07:002015-12-03T07:26:46.432-08:00頻尿也跟下背痛有關係????<div style="text-align: right;">
<span style="font-size: large;">作者:姚斯元 物理治療師</span></div>
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<span style="font-size: x-large;"> 廖先生是30歲的上班族,長年以來一直有右側屁股到大腿後側的疼痛問題,尤其在久坐時特別明顯,有時伴隨著腳麻的現象。由於需要長期坐辦公桌,久坐疼痛的問題更顯得困擾。</span><br />
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<span style="font-size: x-large;"> <br /><br /> 在第一次的治療,幫他做了全身的姿勢,肌肉骨骼的評估檢查,發現主要問題在於右側骨盆過度前傾移位(Pelvis right side anterior rotated),並且因為骨盆移位造成梨狀肌(Piriformis m.)的長度改變而緊繃。於是治療著重在骨盆的矯治跟周邊軟組織放鬆。治療進行了幾次之後,病患的疼痛減少了六七成,但有時候仍會感覺到症狀回到一開始的狀態。<br /><br /> 這樣反反覆覆的效果並不令人滿意,於是再做了一次全身評估,結果發現大腿夾緊(hip adduction)的動作會重現他平常的症狀。右側的骨盆底肌(pelvic floor)非常緊繃且敏感,同時也得知他最近有頻尿的問題。一得知頻尿,心中也更底定了方向,於是為他施做了骨盆肌底的徒手放鬆並且加上牽拉治療,結果症狀得到長足的改善,整整一個禮拜坐辦公桌都沒有感覺到不舒服。<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirl4xR4SrCvKagzZB9NvX1X66d6Z9Co9TJJPBU1fPk88hPGhbFrwY5qoDu59tTYe4RD-uGgoY0u6krDaf8TCcrJU3ADwK_9_b801Xb9u3zH0Jn4KcFZmIEwHcvxKD_CwAhV8B2zLZntPPP/s1600/12003259_907887162621624_2216411747552705581_n.png"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirl4xR4SrCvKagzZB9NvX1X66d6Z9Co9TJJPBU1fPk88hPGhbFrwY5qoDu59tTYe4RD-uGgoY0u6krDaf8TCcrJU3ADwK_9_b801Xb9u3zH0Jn4KcFZmIEwHcvxKD_CwAhV8B2zLZntPPP/s320/12003259_907887162621624_2216411747552705581_n.png" /></a><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVrMGrmD-wCm5x1e70rdMpH7QOops9HM5nfG-3wADLumU6O9k0T9PIaI_M3Vdt5rFz7AuqLYZlEKObReKcO2PSCbFlLvqrGO2GU3poG8pHFEt9ptkvwF93mV3pNytfJnUo6l74s6zr0pIR/s1600/12003267_907886069288400_6134983405404307315_n.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVrMGrmD-wCm5x1e70rdMpH7QOops9HM5nfG-3wADLumU6O9k0T9PIaI_M3Vdt5rFz7AuqLYZlEKObReKcO2PSCbFlLvqrGO2GU3poG8pHFEt9ptkvwF93mV3pNytfJnUo6l74s6zr0pIR/s320/12003267_907886069288400_6134983405404307315_n.jpg" /></a><br /><br /> 骨盆底肌所引發的疼痛是個不常見的疾病,一般會引起骨盆底肌症候群的病人大多是懷孕後的婦女,因為生產之後骨盆底肌的無力(pelvis floor dysfunction) 造成的尿失禁,排尿困難的問題。但近幾年有些研究證實,緊繃的骨盆底肌也會造成下背,骨盆處,或是會陰處疼痛的症狀。而這些疼痛多半伴隨著其他膀胱的症狀如頻尿,排尿疼痛,尿失禁或是性交時疼痛。<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBnM2fFljpYvgUOXd_vp9K8aYUrsYgQuPtr3u_lfRKv9ZEavV19SFbJElMpinQKJowkCND9_CE6bQ45gAIAipX9EpmknVgcefNVFX9Ds_aGeb-D6xETwXVGZQLAIDqO6I6LXBu9NTrPoQy/s1600/12038156_907886072621733_3631665795175766194_n.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBnM2fFljpYvgUOXd_vp9K8aYUrsYgQuPtr3u_lfRKv9ZEavV19SFbJElMpinQKJowkCND9_CE6bQ45gAIAipX9EpmknVgcefNVFX9Ds_aGeb-D6xETwXVGZQLAIDqO6I6LXBu9NTrPoQy/s1600/12038156_907886072621733_3631665795175766194_n.jpg" /></a><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvHCtO0BPYNQCJJXSFiNICg7T3pMvTDZmKC2PywqJEUs93YSwhR83glSpWGBvhkAO45MvzlWLVgfXBWGowft39TbRZhjfaGaEmbhuEn_U97VEFfse2-POJrkayFQP2w8aqABjvMzyJRL0F/s1600/12039657_907887085954965_3512159247018425305_n.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvHCtO0BPYNQCJJXSFiNICg7T3pMvTDZmKC2PywqJEUs93YSwhR83glSpWGBvhkAO45MvzlWLVgfXBWGowft39TbRZhjfaGaEmbhuEn_U97VEFfse2-POJrkayFQP2w8aqABjvMzyJRL0F/s320/12039657_907887085954965_3512159247018425305_n.jpg" /></a><br /><br /> 人體是一個整體,肌筋膜彼此相連,環環相扣。一般而言,不容易聯想平常排尿排泄的問題與下背痛也可以扯上關係?<br /><br /> 所以我們在為客戶做整體評估時,都會希望病人能多提供關於身體的細節,越詳細越好,就是希望能更精準的評估出客戶的症狀根源點,以提供最精確的治療。</span></div>
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作者為 姚思元 主治物理治療師</div>
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<span style="font-size: xx-small;">腳麻怎麼治療 坐骨神經痛怎麼治療 骨盆底肌太緊 根源點治療 尿失禁 CKT療法 肌筋膜放鬆</span><br />
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-38850342210327972942015-09-25T06:33:00.001-07:002015-12-03T07:25:14.526-08:00一個症狀產生的根源點往往意想不到!!<div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: large;">作者:林晉熯 院長</span></div>
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<span style="font-size: x-large;"> 一位有<span style="color: orange;">左側坐骨神經痛</span>多年的客戶,最近這一年來左邊下肢酸麻特別嚴重,由屁股麻到腳底。</span><br />
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<span style="font-size: x-large;">我問他這痠麻的情形在什麼時候或什麼動作會特別明顯? 他都說不知道,就是<span style="color: orange;">突然就發作</span>,然後要過好一陣子,甚至睡著後才消失。<span style="color: orange;">早上起來也是有時會麻有時又蠻正常的</span>。<br /><br />我在為他進行所有的功能性檢測時,都無法誘發出任何些微症狀。<br /><br />只有軀幹旋轉(Trunk rotation in sitting)有些微受限。<br />左側單腳站時會不穩。<br />而我垂直按壓脊椎時,只有L5/S1之間有微酸異樣感。<br /><br />我想檢查到這裡......應該大多數會<span style="color: orange;">直接給他脊骨矯治+臀中肌訓練</span>,強化核心作為治療上的優先選擇。但這樣的效果卻不順人意,症狀反覆依舊,改善不顯著。<br /><br />經全身觸診檢查+動作測試後發現,<span style="color: orange;">根源點竟在左腳足底筋膜</span>,在放鬆足底筋膜後,客戶的腳在當下就輕鬆許多,功能性角度也獲得顯著性的改善。</span><br />
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<span style="font-size: x-large;">於是我要求客戶的回家功課就是<span style="color: orange;">每天用腳踩網球、棒球或高爾夫球來按摩放鬆足底筋膜</span>。客戶的長年下肢酸麻,在六次治療後,並且在近三個月的追蹤下已經不再發生。<br /><br /><br />或許大家會問說為什麼不是治療腰椎,治療腰椎真的沒有效嗎?我相信他的腰一定是有問題的,但不一定就是產生症狀的主要原因。<br /><br /><br /><span style="color: orange;">人的身體是一個整體,當某一個部位產生問題時,身體會不斷代償去維持一個動態平衡;當無法維持時,大腦就會發出疼痛的訊號,於是症狀就產生了。</span></span><br />
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<span style="font-size: x-large;">症狀產生的位置可能是疾病的根源點,也可能只是大腦不願你在身體某處再施加壓力而在他處產生症狀,這<span style="color: orange;">根源點在你意想不到的地方</span>。<br /><br />不管怎麼樣,你總得客觀地去檢查並找出來。</span><br />
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作者為 林晉熯 院長<br />
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<span style="font-size: xx-small;">坐骨神經痛 整脊 推拿 筋膜放鬆術 核心運動 足底筋膜炎 根源點 腰痛 下肢痠麻痛 屁股痛 腰痛 坐骨神經痛怎麼治 CKT療法 解剖列車 </span>Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-38954036714097604802015-08-21T03:18:00.002-07:002015-12-03T07:27:26.987-08:00電腦族常見毛病--手腕痠軟無力<div class="MsoNormal">
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<span style="font-size: large;">作者:姚斯元 物理治療師</span></div>
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<span lang="EN-US" style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank">晉熯脊骨物理治療所</a></span></div>
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<span style="font-size: large;"><a href="http://www.jhspt.com/">http://www.jhspt.com</a></span></div>
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<a href="http://www.facebook.com/linphysiotherapy">http://www.facebook.com/linphysiotherapy</a></div>
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<span style="font-size: large;"><span lang="EN-US"> 20</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲的李小姐是一位需要長期使用滑鼠的補習班工作人員</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">。</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而在長期的使用滑鼠以及批改作文之下</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">右手腕漸漸出現了酸軟無力的現象</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">。</span></span></div>
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<span style="font-size: large;"><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"> 一開始還可以靠著休息緩解</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但隨著時間過去</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">症狀一天比一天嚴重</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">需要休息的時間越來越長</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">甚至漸漸蔓延到手肘</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">無力的問題也與日俱增</span><span lang="EN-US">,</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">甚至已經到了影響工作的程度</span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">。於是決定前來本治療所進行治療,希望能一勞永逸的把症狀根治。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"><br /></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 經過仔細地問診以及理學檢查的程序,我判斷她的症狀並非頸椎,胸椎的異常所引起,更不是局部的神經壓迫。最後評估確定她的<span style="color: orange;">痠麻無力是來自於手腕肌腱的勞損</span>。</span></span></div>
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><span lang="EN-US" style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 由於李小姐的手腕痠麻無力是源自手腕肌肉長期的使用所以引發的慢性發炎,雖然不嚴重,卻非常的難纏,如果要完全根治,需要完全配合治療師教的運動訓練以及建議,不然很容易復發。</span></span></div>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_-z1Em61mMrz_AidpiYnn5tAXHwueeouLzjw_yrvIc1_saGaj_nDBIcEQ2ol138Ym9ArvrtFJAuEA03tNKIuot0KUNi0Ls10tTpW8dOsgwF0cMU4oWUNqp4uwpGVvE1KF7SB1wdeR4AZy/s1600/2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_-z1Em61mMrz_AidpiYnn5tAXHwueeouLzjw_yrvIc1_saGaj_nDBIcEQ2ol138Ym9ArvrtFJAuEA03tNKIuot0KUNi0Ls10tTpW8dOsgwF0cMU4oWUNqp4uwpGVvE1KF7SB1wdeR4AZy/s1600/2.png" /></a></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 在經過溝通之後,李小姐接受了<span style="color: orange;">徒手筋膜放鬆以及震波治療</span>,並且<span style="color: orange;">回家確實地做一天兩次的肌力訓練。疼痛感已有大幅的下降,並且工作時數也一天比一天的拉長了</span>。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhziy3VeMGUwen3SXmq9niipA8aIaYeKiPv8nrxfbJCwlP5q_NlAhyphenhyphenOK7Ag5YYfdqJPnoUz2IKCKUjVn6kA4HbMlQc1vUCP74KozsISd6to4G5nOzXHsAgYpWywptkYRrOjF6hE8IXKRDQu/s1600/3.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhziy3VeMGUwen3SXmq9niipA8aIaYeKiPv8nrxfbJCwlP5q_NlAhyphenhyphenOK7Ag5YYfdqJPnoUz2IKCKUjVn6kA4HbMlQc1vUCP74KozsISd6to4G5nOzXHsAgYpWywptkYRrOjF6hE8IXKRDQu/s320/3.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">震波治療</td></tr>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 像李小姐這樣的手腕痠軟症狀在台灣並不少見,原因是台灣人的工作大多需要使用長時間的電腦滑鼠,此外台灣隨處可見的小吃攤裡面阿姨叔叔也是此情況的危險族群,甚至筆者也曾經受此症狀困擾過。其中<span style="color: orange;">不少是由頸椎受傷而來,但也有很多因由過度使用手腕肌肉而造成慢性發炎與疼痛。</span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 而如前面所提到的,此種慢性發炎非常麻煩與難纏。原因是大多病人不可能因為需要復健而停止工作或是關掉小吃攤,於是即便他在復健復原了<span lang="EN-US">10</span>分,可能又會在回到工作崗位之後又退了<span lang="EN-US">9</span>分。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 在多年的臨床經驗以及實證醫學查證,我發現治療此種慢性疼痛最有效,同時效果最持續的還是<span style="color: orange;">離心性肌力訓練</span>。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;">此訓練有兩個好處<span lang="EN-US">:<o:p></o:p></span></span></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><b><span lang="EN-US" style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-bidi-font-family: 新細明體; mso-bidi-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">1.<span style="font-family: "times new roman"; font-stretch: normal;"> </span></span><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">提供一個動態的拉筋,肌肉被延長之後受到的壓力減輕,對受傷部位的壓力也會減小。<span lang="EN-US"><o:p></o:p></span></span></b></span></div>
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<!--[if !supportLists]--><span style="font-size: large;"><b><span lang="EN-US" style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-bidi-font-family: 新細明體; mso-bidi-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">2.<span style="font-family: "times new roman"; font-stretch: normal;">
</span></span><!--[endif]--></b><span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><b>離心肌力訓練增加了受傷肌肉的力量以及控制能力,肌力增強之後,受傷的肌肉在進行平常的活動的時候就比較不費力,也較不易造成傷害了。</b><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"><span style="color: orange;">離心肌力運動的建議訓練量是一天<span lang="EN-US">2~3</span>次,一次<span lang="EN-US">15</span>下</span>,重量建議拿到你大概可以舉<span lang="EN-US">10</span>次就會沒力的重量<span lang="EN-US">(</span>一般男生約是<span lang="EN-US">2~3KG </span>女生約<span lang="EN-US">1~2KG)
</span>,運動時如圖一樣把手平放在桌子上或是膝蓋上,彎曲手腕之後緩慢並且流暢的放平<span lang="EN-US">,</span>注意緩慢以及流暢是此運動的重點,而做完彎曲手腕之後也可翻面作伸腕的運動。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;">手腕痠軟是很惱人的一個症狀,而<span style="color: orange;">因為人每天都要大量地使用手部的功能,所以運動的訓練比其他部位來說更加的重要。但除此之外,頸部或是胸部的疾病也常會有手腕的傳導痛。所以接受完整的物理治療評估以及治療才是找出根源,遠離疼痛最好的方法。</span></span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> 姚斯元 主治物理治療師</span></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"><br /></span></span>
<span style="font-family: "新細明體" , "serif"; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;"><span style="font-size: large;"> </span></span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-10490424802702332642015-06-15T07:34:00.000-07:002015-12-03T07:28:06.864-08:00跑步膝蓋痛,竟是脊椎惹的禍!!<div class="MsoNormal">
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<span style="font-size: large;">作者:林晉熯 院長</span></div>
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<span lang="EN-US" style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank">晉熯脊骨物理治療所</a></span></div>
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<span style="font-size: large;"><a href="http://www.jhspt.com/">http://www.jhspt.com</a></span></div>
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<span style="font-size: large;"><a href="http://www.facebook.com/linphysiotherapy">http://www.facebook.com/linphysiotherapy</a></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilCX-mGaBwt5uRbs5dVfQIolhnGd-WzUJZGbrL0U-_9KcM_UMvJgnbtlIzY4bUyGV1KLlQvIR-WjnqEM_oAzHydU3ZXLi_ielbfVJloNniNWpHJX4T2VFaCj-O6wZWudUbJcuISYsfHQbb/s1600/0.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilCX-mGaBwt5uRbs5dVfQIolhnGd-WzUJZGbrL0U-_9KcM_UMvJgnbtlIzY4bUyGV1KLlQvIR-WjnqEM_oAzHydU3ZXLi_ielbfVJloNniNWpHJX4T2VFaCj-O6wZWudUbJcuISYsfHQbb/s320/0.jpg" width="320" /></a><span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><br /></span></span>
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"> </span><span style="font-family: 標楷體;">熱愛玩三鐵、跑馬拉松的楊先生,最近這兩三個月在跑步時,常會有<span style="color: orange;">左側膝蓋痛</span>的現象,而且<span style="color: orange;">症狀隨時間和跑步距離不斷加劇</span>,由原本跑個二十多公里才痛,到跑個五公里就痛到腿軟了。醫師診斷的結果也只說是<span style="color: orange;">肌肉拉傷</span>,而上網查資料和跑友討論,<span style="color: orange;">以為自己是髂脛束摩擦症候群</span>,不斷按摩的結果也是沒有改善</span><span lang="EN-US" style="font-family: "times new roman" , serif;">…</span></span></div>
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<span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">楊先生經由朋友介紹來我的物理治療所接受評估與治療。發現他的身體肌肉很強壯,但也十分緊繃,功能性動作評估發現<span style="color: orange;">右側膝蓋彎曲角度受限</span></span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">(Right knee flexion ROM limitation)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,只能到<span style="color: orange;">約</span></span><span lang="EN-US" style="color: orange; font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">90</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: orange;">度</span>;左腳單腳站時,骨盆會傾斜</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">(Trendelenburg sign)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">;但是兩側臀中肌的肌力檢測卻又正常</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">…</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">。</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">我驚訝的問他:「怎麼你右腳膝蓋只到</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">90</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">度</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">?? </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">以前有受傷過嗎</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">?</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">」</span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">楊先生:「沒有受過傷啊,那大學時就這樣了,這不是天生的嗎</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">? </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">以前到現在就無法上蹲式馬桶,也無法作蹲坐的姿勢。我還以為我天生右邊筋骨特別硬</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">…</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">」</span></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQdT1HYCSbL0S1D5zuW1svotQTnn4__WTxPZEavMeyKGA_2U22cFuWQ9aJI_UQ02HRzzah-TUzm5x6y3jp7ruxzKV7ooCMBaDaKU86W1_br0Kh6ctGFaol5FXtzn7Pezul5L1_FvGS1qaO/s1600/images+%25281%2529.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQdT1HYCSbL0S1D5zuW1svotQTnn4__WTxPZEavMeyKGA_2U22cFuWQ9aJI_UQ02HRzzah-TUzm5x6y3jp7ruxzKV7ooCMBaDaKU86W1_br0Kh6ctGFaol5FXtzn7Pezul5L1_FvGS1qaO/s200/images+%25281%2529.jpg" width="200" /></a></span></div>
<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span><br />
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">我又驚訝的回答:「這應該是長年累積的結果</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">…</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">只是有點誇張就是了,可能妳的體質強壯,一直撐到現在才有症狀出現</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">…</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">」</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">這位個案在經過詳細的整體評估後發現,調整<span style="color: orange;">腰椎第一節</span></span><span lang="EN-US" style="color: orange; font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">(L1)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: orange;">可有效改善他的右側膝蓋彎曲角度</span>,而且在第一次治療後的隔天跑步,<span style="color: orange;">膝蓋痛也大幅減輕許多</span>,重要的是終於<span style="color: orange;">可以上蹲式馬桶</span>了</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">…</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">在經過約</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">6</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">次治療,已經可以騎腳踏車約</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">120</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">公里而沒有疼痛感</span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;">~<o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"> </span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: orange;">當有功能性動作受到限制時,容易導致肌筋膜鏈鎖住,神經肌肉控制失調或抑制了本該用力的肌肉,導致一連串不必要的代償,影響整體平衡,增加肌肉關節負擔。只有仔細評估找出「鎖住身體的症狀元凶」並解開它,才能有效解決問題。</span></span></span><span lang="EN-US" style="font-family: "times new roman" , "serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></div>
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<span style="font-size: x-large;">https://www.jhspt.com</span><br />
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<span style="background-color: white; font-family: 標楷體; font-size: xx-small;">Redcord neurac、ISAT、懸吊運動、整脊、肌筋膜、激痛點、按摩、下背痛、腰痛、臀中肌、臀大肌、椎間盤突出、三鐵、馬拉松、肌肉拉傷、髂脛束摩擦症候群 根源點治療 膝蓋痛怎麼辦 脊椎錯位 腰痛怎麼治 騎腳踏車腰痛 膝蓋外側痛 膝蓋內側痛</span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-41630836047275882922015-05-08T05:31:00.001-07:002015-12-03T07:28:42.002-08:00手麻手痠: 一定是頸椎壓迫嗎?<div class="p0" style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="font-size: large;">作者:姚斯元 物理治療師</span></div>
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<span style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank">晉熯脊骨物理治療所</a></span></div>
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<span style="font-size: large;"><a href="http://www.facebook.com/linphysiotherapy">http://www.facebook.com/linphysiotherapy</a></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">“</span><span style="font-family: 標楷體;">老師<span lang="EN-US">,</span><span style="color: orange;">我手會麻</span><span lang="EN-US">” </span>對每個治療師來說<span lang="EN-US">,</span>這句話一定不陌生。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span style="color: orange; font-family: 標楷體;">手麻,</span><span style="font-family: 標楷體;">幾乎是物理治療中最常見的症狀之一了,治療師看到它都跟看到老朋友一樣。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">而臨床上,手麻的症狀也常常會和"<span style="color: orange;">神經根壓迫</span>"作連結。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體;"><span style="font-size: x-large;"> </span></span><span style="font-family: 標楷體;"><span style="font-size: x-large;">常見於頸椎的錯位或是肌肉攣縮造成病患抬頭時壓迫到神經根,造成手掌的麻刺不適感</span><span lang="EN-US" style="font-size: 20pt;"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCyLATLfeHWYcnX_SEjqr8QMmHUXAbpn7IHaW0tiTz0ZQWiePlkk1JzTs54yZn74lauwY-Ee8b-OqCoMQxOkgQmvgoV8O_I51filY17ZhbvYLTd7_QDWbHUZi9Sjj4fogRnx3XLeOCbMPc/s1600/disc-herniation-copy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: x-large;"><img border="0" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCyLATLfeHWYcnX_SEjqr8QMmHUXAbpn7IHaW0tiTz0ZQWiePlkk1JzTs54yZn74lauwY-Ee8b-OqCoMQxOkgQmvgoV8O_I51filY17ZhbvYLTd7_QDWbHUZi9Sjj4fogRnx3XLeOCbMPc/s640/disc-herniation-copy.jpg" width="640" /></span></a></div>
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<span style="font-family: 標楷體; font-size: xx-small;"> <span style="font-size: x-large;"> </span></span><span style="font-size: x-large;"><span style="font-family: 標楷體;">但是,</span><span style="color: yellow; font-family: 標楷體;">並不是每一個病患的手麻症狀都起源於神經根。</span></span><br />
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<span style="color: orange; font-size: x-large;">手麻真的就是脖子的問題嗎?</span><br />
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">透過治療師詳細謹慎的評估之下,有時會得出完全不同的病因。</span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 16pt;"><o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_aO-Z0T8iKHwkRDZraz55sI-_d8Z6nBAMpHwjDJI9yQxZ48ISPcgGhGisMhoj-y2dA2nLJYJ1jLBOkegDGQYDDVwiCES0FvxGtqeND3xKqYs98WkjStopAdF0wkYM_96j9p6eJKQdXbIy/s1600/hqdefault.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: x-large;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_aO-Z0T8iKHwkRDZraz55sI-_d8Z6nBAMpHwjDJI9yQxZ48ISPcgGhGisMhoj-y2dA2nLJYJ1jLBOkegDGQYDDVwiCES0FvxGtqeND3xKqYs98WkjStopAdF0wkYM_96j9p6eJKQdXbIy/s320/hqdefault.jpg" width="320" /></span></a></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">以下即是一個案例評估過程的分享,也可印證物理治療評估的重要性。</span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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</span><span style="font-family: 標楷體;">個案是<span lang="EN-US">35</span>歲的女性<span lang="EN-US">,</span>主訴為<span lang="EN-US">"</span></span><span style="color: orange; font-family: 標楷體;">騎車一段時間後<span lang="EN-US">,</span>雙手會麻</span><span lang="EN-US" style="font-family: 標楷體;">",</span><span style="font-family: 標楷體;">其他時候<span lang="EN-US">(</span>包括用電腦<span lang="EN-US">,</span>低頭看書<span lang="EN-US">,</span>轉頭<span lang="EN-US">)</span>都不會有任何症狀。</span></span><span lang="EN-US" style="font-family: 標楷體;"><span style="font-size: x-large;"> </span><span style="font-size: 13.5pt;"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8aZcjIyC2ygEHLebgms8Qp6qC9enmC5z-KWgxF0sYJAC6B3Jg5LIQPPDhtmr_GyvtbYhaB_BmEqhTArh258SB9GGD8bfubn7L4z_HEqmsE-ymFzt6xrTK1Ob1iRFXFY2TmZ7HNcSvC3aB/s1600/1070010029.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: x-large;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8aZcjIyC2ygEHLebgms8Qp6qC9enmC5z-KWgxF0sYJAC6B3Jg5LIQPPDhtmr_GyvtbYhaB_BmEqhTArh258SB9GGD8bfubn7L4z_HEqmsE-ymFzt6xrTK1Ob1iRFXFY2TmZ7HNcSvC3aB/s320/1070010029.jpg" width="320" /></span></a></div>
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<span style="font-family: 標楷體; font-size: xx-small;"><span style="font-size: x-large;"> </span></span><span style="font-size: x-large;"><span style="font-family: 標楷體;">經過詳細的詢問病史下</span><span lang="EN-US" style="font-family: 標楷體;">,</span><span style="font-family: 標楷體;">個案並無心血管疾病的病史</span><span lang="EN-US" style="font-family: 標楷體;">,</span><span style="font-family: 標楷體;">平時生活沒有任何會傷害血管神經的不良嗜好</span><span lang="EN-US" style="font-family: 標楷體;">(</span><span style="font-family: 標楷體;">譬如抽菸、酗酒</span><span lang="EN-US" style="font-family: 標楷體;">)</span><span style="font-family: 標楷體;">。也沒有服用任何有神經症狀副作用的藥物。</span></span><br />
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<span class="apple-converted-space"> </span></span><span style="font-family: 標楷體;">於是,排除掉內科問題(譬如腫瘤壓迫到脊隨),以</span><span style="color: yellow; font-family: 標楷體;">肌肉骨骼問題</span><span style="font-family: 標楷體;">來看,如果</span><span style="color: yellow; font-family: 標楷體;">病人雙手會麻,而且是整隻手的麻</span><span style="font-family: 標楷體;">,一般來說幾種可能</span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 13.5pt;"><o:p></o:p></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">1. </span><span style="font-family: 標楷體;">第<span lang="EN-US">4</span>胸椎症候群<span lang="EN-US">(T4 syndrome)</span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">2. </span><span style="font-family: 標楷體;">胸廓出口症候群<span lang="EN-US"> (Thoracic outlet syndrome )</span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">3. </span><span style="font-family: 標楷體;">頸椎的椎間盤突出<span lang="EN-US"> </span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">4. </span><span style="font-family: 標楷體;">雙側頸椎神經根同時被壓迫<span lang="EN-US">(</span>除非是老年人不然非常的少見<span lang="EN-US">)</span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="color: black; font-family: 標楷體;"><span style="font-size: x-large;">透過個案的騎車動作分析<span lang="EN-US">,</span>可以發現她的姿勢如下<span lang="EN-US">:</span></span></span><span lang="EN-US" style="color: black; font-family: 標楷體; font-size: 13.5pt; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="font-size: x-large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7gskVCxrd7kLTLtQmf31DgxuC978jY7YddJ86wGKml_X5KgjprUJDj5SEeYAn6veBk07zCU4AibvmQ_uixwdCt8unPNLiMFlW_pGem4hzPc49MZLqVpzV9m5vCMJnb1O28x3LqmfU6aPq/s1600/upper-crossed-syndrome.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7gskVCxrd7kLTLtQmf31DgxuC978jY7YddJ86wGKml_X5KgjprUJDj5SEeYAn6veBk07zCU4AibvmQ_uixwdCt8unPNLiMFlW_pGem4hzPc49MZLqVpzV9m5vCMJnb1O28x3LqmfU6aPq/s400/upper-crossed-syndrome.jpg" width="341" /></a> </span><br />
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<span style="font-size: x-large;"><span style="font-family: 標楷體; font-size: 24pt;">透過圖片可以看到上頸椎是伸展<span lang="EN-US">(extension) </span>而下頸椎是屈曲<span lang="EN-US">(flexion)</span>的。或者說簡單一點<span lang="EN-US">,</span></span><span style="color: yellow; font-family: 標楷體; font-size: 24.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-language: ZH-TW;">上頸椎是往後仰而下頸椎是往前彎的,而胸椎是往前彎的<span lang="EN-US">(</span>駝背姿勢<span lang="EN-US">)</span>。</span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 24pt;"><span style="font-size: x-large;"> </span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN8XsDLYvkPFai1sUfR8jbknciSvEoRuu5y3itT3Nb4eFiCFiK-cVtqPnRZXH0qrMK8yrHjEi2iu-hJmVO5bVhMQFvVhQlV2Qrm6Xk_ZducQAzVKJp_fxJFq4xk9QltOHboKJpmFiw4Y-r/s1600/Carpal-Tunel-and-the-Neck-01.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: x-large;"><img border="0" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN8XsDLYvkPFai1sUfR8jbknciSvEoRuu5y3itT3Nb4eFiCFiK-cVtqPnRZXH0qrMK8yrHjEi2iu-hJmVO5bVhMQFvVhQlV2Qrm6Xk_ZducQAzVKJp_fxJFq4xk9QltOHboKJpmFiw4Y-r/s400/Carpal-Tunel-and-the-Neck-01.jpg" width="400" /></span></a></div>
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<span style="font-family: 標楷體; font-size: xx-small;"><span style="font-size: x-large;"> </span></span><span style="font-family: 標楷體;"><span style="font-size: x-large;">再幫個案評估頸部屈曲、後仰、旋轉、側彎等皆不會引發疼痛,個案自敘在平時,頸部的動作也很少引發症狀。甚至長時間低頭看書也鮮少會有不舒服的症狀產生。</span></span><br />
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</span><span style="font-family: 標楷體;">由此可推斷頸椎神經根壓迫亦或是椎間盤突出的可能性也不大。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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</span><span style="font-family: 標楷體;">而第<span lang="EN-US">4</span>胸椎症候群常會在胸椎彎曲時引發症狀;騎車時的頸部動作會使脖子的肌肉會緊<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">繃而造成胸廓出口症候群。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">透過動作分析,我們已將可能性縮小到兩個<span lang="EN-US">:<o:p></o:p></span></span></span></div>
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</span><span style="color: orange; font-family: 標楷體;">1.第<span lang="EN-US">4</span>胸椎症候群<span lang="EN-US">(T4 syndrome)</span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="color: orange; font-family: 標楷體;"><span style="font-size: x-large;">2.胸廓出口症候群<span lang="EN-US"> (Thoracic outlet syndrome )</span></span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 22pt;"><o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRsCcdq72nKW5tM8BsB49xf-TeN9-CKjmGWhyKagtJ30kgnbYTlVvfusA2rVHgHeYmAgjxtlKV7uMIGBKIkBemfVtmLUHS6CNoJNwe678mYH572RK025dctHlgcjJP-uot4SYOo11RFrxD/s1600/hyper1347151249499.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: x-large;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRsCcdq72nKW5tM8BsB49xf-TeN9-CKjmGWhyKagtJ30kgnbYTlVvfusA2rVHgHeYmAgjxtlKV7uMIGBKIkBemfVtmLUHS6CNoJNwe678mYH572RK025dctHlgcjJP-uot4SYOo11RFrxD/s320/hyper1347151249499.jpg" width="224" /></span></a><span style="font-family: 標楷體;"><span style="font-size: x-large;"> </span><span style="font-size: large;"> </span></span><span style="font-family: 標楷體;"><span style="font-size: x-large;">理學檢查時,病患的神經檢查(肌力,感覺,反射)都是正常。</span></span><br />
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">個案在頸椎和胸椎的動作評估上並未引發任何症狀。而肩頸肌肉都偏僵硬。</span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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</span><span style="font-family: 標楷體;">在<span style="color: orange;">檢測胸廓出口症候群的測試<span lang="EN-US">--</span></span></span><span style="color: orange;"><span style="color: orange; font-family: 標楷體;">萊特試驗</span><span lang="EN-US" style="color: orange; font-family: 標楷體;">(<br />
wright’s test)</span><span style="font-family: 標楷體;">以及</span><span style="color: orange; font-family: 標楷體;">魯斯測試</span><span lang="EN-US" style="color: orange; font-family: 標楷體;">(Roo's test)</span><span style="color: orange; font-family: 標楷體;">都是陽性</span><span style="font-family: 標楷體;">。</span></span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDhRqbnAhoFcypUBkxHUpRp5kpYUGBT-tDVUQClT8DX7EANxJ8Sm0ZThJC5iB7kbhl_SDfm9Q8LGV_3tIhajlAKMH5u9JgMTQMwPtaQ2WvHyLlkJrRJdsIoLwMjnUoEgqZKgXabCNL3T2l/s1600/maxresdefault.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDhRqbnAhoFcypUBkxHUpRp5kpYUGBT-tDVUQClT8DX7EANxJ8Sm0ZThJC5iB7kbhl_SDfm9Q8LGV_3tIhajlAKMH5u9JgMTQMwPtaQ2WvHyLlkJrRJdsIoLwMjnUoEgqZKgXabCNL3T2l/s320/maxresdefault.jpg" width="320" /></span></a></div>
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<span style="font-family: 標楷體; font-size: xx-small;"><span style="font-size: large;"> </span><span style="font-size: x-large;"> </span></span><span style="font-size: x-large;"><span style="font-family: 標楷體;">評估至此</span><span lang="EN-US" style="font-family: 標楷體;">,</span><span style="font-family: 標楷體;">病患的病因已經逐漸明朗</span><span lang="EN-US" style="font-family: 標楷體;">,</span><span style="font-family: 標楷體;">特別測試都是陽性</span><span lang="EN-US" style="font-family: 標楷體;">,</span><span style="font-family: 標楷體;">而<span style="color: orange;">不正確的姿勢以及僵硬的頸椎同時也是胸廓出口症候群的危險因子</span>。</span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 24pt;"> </span></div>
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<span style="font-size: large;"><span style="font-family: 標楷體;"> </span></span><span style="font-size: x-large;"><span style="color: orange; font-family: 標楷體;">胸廓出口症侯群</span><span style="font-family: 標楷體;"><span style="color: orange;">的病因大多是神經受肌肉壓迫造成。</span>我們的神經和血管從頸椎出來之後<span lang="EN-US">,</span>會先穿過肩頸肌肉的縫隙之間<span lang="EN-US">,</span>然後才走進<span lang="EN-US"> </span></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhCivAtCV1wBgolRZbFOu9qH-ZHXm7gf9Ud_1FTkfUJ5tM6fOfi6s2DL3BtlRGkOH1XL5iLzotycEHf5R8jtDw36TKwCUrZsp2nnul1pa9Z-RvjPbv-6U0nh6CgvAX33tjs3nQakLdGPMw/s1600/tos.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhCivAtCV1wBgolRZbFOu9qH-ZHXm7gf9Ud_1FTkfUJ5tM6fOfi6s2DL3BtlRGkOH1XL5iLzotycEHf5R8jtDw36TKwCUrZsp2nnul1pa9Z-RvjPbv-6U0nh6CgvAX33tjs3nQakLdGPMw/s1600/tos.gif" /></span></a></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">手臂<span lang="EN-US">,</span>幫我們傳遞大腦的訊息到手部<span lang="EN-US">,</span>但是如果<span style="color: orange;">肩頸胸肌肉太緊<span lang="EN-US">(</span>譬如<span lang="EN-US">: </span>斜角肌、胸小肌<span lang="EN-US">)</span>,肌肉縫隙變小、壓力變大就會造成神經及血管受夾擠,導致手麻手痛的症狀。</span><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span class="apple-converted-space"> </span></span><span style="font-family: 標楷體;">於是<span lang="EN-US">,</span>經過</span><span style="color: orange; font-family: 標楷體;">放鬆肩頸和胸廓的肌肉筋膜</span><span style="font-family: 標楷體;">後,個案在下一次的回診時就跟我說<span lang="EN-US">: <o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;">"</span><span style="color: orange; font-family: 標楷體;">老師<span lang="EN-US">,</span>我現在騎車手就完全不會麻</span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="color: orange; font-family: 標楷體;">了</span><span lang="EN-US" style="font-family: 標楷體;">" <o:p></o:p></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">這句話應該是全世界的治療師最喜歡聽到的一句話了。</span><span lang="EN-US" style="font-size: 22pt;"><o:p></o:p></span></span></div>
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<tr><td class="tr-caption" style="text-align: center;">胸廓出口症候群,肌筋膜放鬆示意圖。</td></tr>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;"> </span></span><span style="font-size: x-large;"><span style="font-family: 標楷體;">但是症狀解決才只是物理治療的一部分,接下來就是持續的肩頸放鬆與</span><span style="color: orange; font-family: 標楷體;">姿勢矯正</span><span style="font-family: 標楷體;">,預防症狀的再復發。</span></span><br />
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</span><span style="font-family: 標楷體;">總結來說<span lang="EN-US">: </span>雖然大部分手麻的情況都是從頸椎或是胸椎的結構而來<span lang="EN-US">,</span>但是還是有一些的案例來自於脊椎以外的結構。</span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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</span><span style="font-family: 標楷體;">唯有</span><span style="color: orange; font-family: 標楷體;">整體系統性的詳細評估<span lang="EN-US">,</span>才能抓出這些病因<span lang="EN-US">,</span>進而達到最好的療效</span><span style="font-family: 標楷體;">。</span></span><span lang="EN-US" style="font-family: 標楷體; font-size: 13.5pt;"><o:p></o:p></span></div>
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<b><span style="font-family: 標楷體; font-size: xx-small;">作者<span lang="EN-US">: </span>姚斯元 主治物理治療師<span class="apple-converted-space"><span lang="EN-US"> </span></span></span></b></div>
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<b><b><span style="font-family: 標楷體; font-size: xx-small;"><span lang="EN-US"> </span>晉熯脊骨物理治療所</span></b></b><br />
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<span style="font-size: xx-small;"><span style="background-color: #141414; color: #444444; font-family: 新細明體; font-size: xx-small; line-height: 12.6000003814697px;">Redcord neurac、<span style="font-family: "times new roman";">ISAT</span>、懸吊運動、整脊、肌筋膜、</span><span style="background-color: #141414; color: #444444; font-family: 新細明體; font-size: xx-small; line-height: 12.6000003814697px;">激痛點、按摩、肩頸痛、肩膀痛、手痛、下背痛、腰痛、</span><span style="background-color: #141414; color: #444444; font-family: 新細明體; font-size: xx-small; line-height: 12.6000003814697px;">臀中肌、臀大肌、椎間盤突出、高爾夫球、揮桿、閃到腰、肌肉拉傷、胸廓出口症候群、騎車手麻 手麻怎麼辦 頸椎長骨刺 氣血不通 手麻是脖子的問題嗎? 騎車時手麻怎麼辦 手麻怎麼辦 手麻怎麼治療</span></span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-55414974713787093552015-03-06T02:38:00.003-08:002015-12-03T07:29:19.869-08:00高爾夫球愛好者的困擾:腰痛、肩膀痛、手指痛<div class="p0" style="margin-bottom: 0pt; margin-top: 0pt; text-indent: 32.0000pt;">
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<span lang="EN-US" style="font-size: large;">作者:林晉熯 院長</span></div>
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<span style="font-size: large;"> <a href="http://www.jhspt.com/" target="_blank"> 晉熯脊骨物理治療所</a></span></div>
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<a href="http://www.jhspt.com/"><span style="font-size: large;">http://www.jhspt.com</span></a></div>
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<a href="http://www.facebook.com/linphysiotherapy">http://www.facebook.com/linphysiotherapy</a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAXpfrv8lS04hcykBUNUMPwAwKys8-4icdAeQ7Y7MjM9oxb-FN0UwmYJ_rs8P8oebKoRKeOFidJh4u75f3q19l4FIfUxW0to5du4o_4a6VcfdZBY81dgPEHac4YqLDCKbyEz2dWttP3kg4/s1600/Kuala-Lumpur-Golf-and-Country-Club2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAXpfrv8lS04hcykBUNUMPwAwKys8-4icdAeQ7Y7MjM9oxb-FN0UwmYJ_rs8P8oebKoRKeOFidJh4u75f3q19l4FIfUxW0to5du4o_4a6VcfdZBY81dgPEHac4YqLDCKbyEz2dWttP3kg4/s1600/Kuala-Lumpur-Golf-and-Country-Club2.jpg" width="320" /></a><span style="font-size: x-large;"><span style="font-family: 標楷體;"> 約58歲的何先生是一位深愛<span style="color: orange;">高爾夫球</span>的人,</span><span style="font-family: 標楷體;">”</span><span style="font-family: 標楷體;">三日不打球,渾身不對勁</span><span style="font-family: 標楷體;">”</span><span style="font-family: 標楷體;">這句話用在他身上一點也不為過。因為<span style="color: orange;">下背痛</span>,讓他平時非常困擾,只有在打球的時候才會感到下背舒服些。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 何先生主訴在<span style="color: orange;">早上起床時下背痛最明顯</span>,常要滾動個兩三分鐘才好下床;而<span style="color: orange;">打球後很明顯會感到</span></span><span style="color: orange;"><span style="color: #ffcc00; font-family: 標楷體;">右側下背痛</span><span style="font-family: 標楷體;">,同時併發</span><span style="color: #ffcc00; font-family: 標楷體;">左側肩膀的痠痛</span><span style="font-family: 標楷體;">,以及</span><span style="color: #ffcc00; font-family: 標楷體;">右手中指的敏感疼痛</span></span><span style="font-family: 標楷體;">。這樣的病痛已經困擾不知幾年了,去找醫生檢查後也都說沒問題,X-ray也看不出任何異狀。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmnlLWB4Cvb4WH0T0o3d7iV5aM0S4BCOGZiC7T8M-6akpdlDBAk7mmx_zXwqRWrP2-hfXTUrLv6HurtiW_EWVhSCwQOmtEMuIpyhk_ZMHEIJ6LdEUQsACGTfzy_yJoP-1p6j_GDS5Ml8c0/s1600/Quadratus+Lumborum+(3).jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmnlLWB4Cvb4WH0T0o3d7iV5aM0S4BCOGZiC7T8M-6akpdlDBAk7mmx_zXwqRWrP2-hfXTUrLv6HurtiW_EWVhSCwQOmtEMuIpyhk_ZMHEIJ6LdEUQsACGTfzy_yJoP-1p6j_GDS5Ml8c0/s1600/Quadratus+Lumborum+(3).jpg" width="164" /></a><span style="font-size: x-large;"><span style="font-family: 標楷體;"> 在經過問診和理學評估後,發現胸椎向右旋轉角度相較於左邊是受限的(Right trunk rotation limited),肩膀右高左低;右側腰方肌(Quadratus lumborum)有局部肌肉筋攣的激痛點;右手前臂近端屈指肌(Right flexor digitorum)也有肌肉筋攣。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_SRLd3j-LRP4olviy8R5KyzLeDiI5BpHJARWiEYG6FsQtsnIPC_TI6u0-_wxgu2KJMNg8tgyod0-Ffy9A1UuqbT3EiLka-akuJEiorZYpdDcjIvgkOmaGsH9VbdVYEwIM0TjEJ6CWbzJ6/s1600/Flexor_Digitorum_Superficialis__Protundus.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_SRLd3j-LRP4olviy8R5KyzLeDiI5BpHJARWiEYG6FsQtsnIPC_TI6u0-_wxgu2KJMNg8tgyod0-Ffy9A1UuqbT3EiLka-akuJEiorZYpdDcjIvgkOmaGsH9VbdVYEwIM0TjEJ6CWbzJ6/s1600/Flexor_Digitorum_Superficialis__Protundus.jpg" width="200" /></a><span style="font-size: x-large;"><span style="font-family: 標楷體;"> 主因則是</span><span style="color: orange;"><span style="color: #ffcc00; font-family: 標楷體;">左側臀大肌(left gluteal max.)和右側臀中肌(Right gluteal medius)在神經肌肉控制上較</span><span style="font-family: 標楷體;">差,因此才會在打高爾夫球揮桿時,產生肌肉代償,致使</span><span style="color: #ffcc00; font-family: 標楷體;">腰方肌過度負荷</span></span></span><span style="font-size: x-large;"><span style="color: orange; font-family: 標楷體;"><span style="font-size: x-large;"><span style="font-family: 標楷體;">筋攣</span></span>而下背痛</span><span style="font-family: 標楷體;">;因此在揮桿動作失去整體協調,左側上斜方肌(Left upper trapezius)代償,用力過度而痠痛,同時胸腰筋膜(Thoracolumbar fascia)繃緊鎖住胸椎也會使左側肩膀產生肌肉代償,使其雪上加霜。右手中指痛則是因為在揮桿時的反作用力造成,</span><span style="color: #ffcc00; font-family: 標楷體;">重複性的大力揮桿使右邊屈指肌肌肉經攣導致的轉移痛。</span><span style="color: #ffcc00; font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> <span style="color: orange;">右側腰方肌和屈指肌群的肌筋膜放鬆後,症狀立即改善,胸椎旋轉角度也因此增加許多,肩膀的疼痛自然就緩和不痛</span>了,很開心的是早上起床也沒有下背痛困擾,可以自然的下床了。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">另外,在經過六次的</span><span style="color: orange;"><span style="color: #ffcc00; font-family: 標楷體;">redcord neurac懸吊運動訓練</span><span style="font-family: 標楷體;">,</span><span style="color: #ffcc00; font-family: 標楷體;">改善左臀大肌和右臀中肌的神經肌肉控制</span></span><span style="font-family: 標楷體;">,何先生在療程結束後告訴我說: 「終於可以用標準揮桿姿勢揮桿,球可以飛更遠啦,以前怕痛都不敢,現在終於好了,真高興。」</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 一個完善的物理治療,</span><span style="color: #ffcc00; font-family: 標楷體; font-weight: bold;">除了評估找出主因之外,<span style="color: orange;">不僅要放鬆筋攣的肌肉或激痛點,更要強化導致整體代償的肌肉群,強化神經肌肉控制,進而預防傷害的再度發生。</span></span></span><span style="color: #ffcc00; font-family: "標楷體"; font-size: 16.0000pt; font-weight: bold; mso-spacerun: 'yes';"><o:p></o:p></span></div>
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<span style="font-size: x-large;">http://www.jhspt.com</span></div>
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<span style="color: #444444; font-size: xx-small;"><span style="font-family: 新細明體;">Redcord neurac<span style="font-family: 新細明體;">、</span><span style="font-family: "times new roman";">ISAT</span><span style="font-family: 新細明體;">、懸吊運動、整脊、肌筋膜、</span></span><span style="font-family: 新細明體;">激痛點、按摩、肩頸痛、肩膀痛、手痛、下背痛、腰痛、</span><span style="font-family: 新細明體;">臀中肌、臀大肌、椎間盤突出、高爾夫球、揮桿、閃到腰、肌肉拉傷 高爾夫球肘怎麼治 打高爾夫腰痛背痛腳麻手麻</span></span><span style="font-family: 新細明體; font-size: 10.5pt;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-50575524238908074312015-03-05T05:21:00.003-08:002015-12-03T07:30:30.173-08:00跑步愛好者的困擾:腿痠、膝痛、肩膀痛<div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: large;">作者:林晉熯<a href="http://www.jhspt.com/" target="_blank"> 院長</a></span></div>
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<span style="font-size: large;"><a href="http://www.jhspt.com/" target="_blank">晉熯脊骨物理治療所</a></span></div>
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<span style="font-size: large;"><a href="http://www.jhspt.com/">http://www.jhspt.com</a></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglsjJ8qprKYjcdEGz8cyBquAfDU-epyPVSApm8eusFvdlCkdHo5groIEdnjVMZZHEybUgn5ySJUpHnNCpoKsupxbbw5vKEfngDPwiaI-J5nBgnjn1mNv62SYeYWwgj6jTREN2FWD9UqVrp/s1600/running.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglsjJ8qprKYjcdEGz8cyBquAfDU-epyPVSApm8eusFvdlCkdHo5groIEdnjVMZZHEybUgn5ySJUpHnNCpoKsupxbbw5vKEfngDPwiaI-J5nBgnjn1mNv62SYeYWwgj6jTREN2FWD9UqVrp/s1600/running.jpg" width="320" /></a><span style="font-size: x-large;"><span style="font-family: 標楷體;"><br /></span></span><br />
<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 邁入中年的</span><span style="font-family: 標楷體;">陳先生以前喜歡打高爾夫,近來卻愛上跑步,常參加國內各種馬拉松賽事。在這三個月來卻發現當跑步超過</span><span style="font-family: 標楷體;">10公里後,</span><span style="font-family: 標楷體;"><span style="color: orange;">左邊大腿外側很容易痠痛,膝蓋內側以及肩膀右邊也伴隨著疼痛</span>;這近一個月更嚴重,跑不到3公里大腿就明顯痠痛的不能再繼續,只能一跛一跛的回家休息,同時<span style="color: orange;">左邊膝蓋外側,和右腳的第三、第四根蹠骨背側也開始痛了</span>。</span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwy1TVXG23nUpxDK2yy28ZprnAG3QcCNzx8qd4Kp8yu55y-aYEgJAnJZol2at9wJBzAHbL7_DyOZuitZXbBTAihQe88w9vlHq6XiEkC1dc1WwqiY91w0hHoq392ptgS1VVwIpLeL3xfkOu/s1600/knee-pain.jpg" imageanchor="1" style="clear: right; float: right; font-family: 標楷體; margin-bottom: 1em; margin-left: 1em; text-align: center;"><span style="font-size: x-large;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwy1TVXG23nUpxDK2yy28ZprnAG3QcCNzx8qd4Kp8yu55y-aYEgJAnJZol2at9wJBzAHbL7_DyOZuitZXbBTAihQe88w9vlHq6XiEkC1dc1WwqiY91w0hHoq392ptgS1VVwIpLeL3xfkOu/s1600/knee-pain.jpg" width="133" /></span></a></div>
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<span style="font-family: 標楷體; text-indent: 28pt;"><span style="font-size: x-large;"> 陳先生查看網路和書籍資料<span style="color: orange;">以為是髂脛束摩擦症候群或坐骨神經痛</span>,於是又拼命的按摩髂脛束,用滾筒滾的痛得要死又<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjImTftSAuveZ7IG3cyALGbhFF6hKOOs2jAeQx4tdSVzKtKBL8eoD881La0SvcYdXm1r-AXeuXf_Nn0tJHcZVe3C680YqAZ8DjNkXzQHWAjLAnkwu9x1f4ef1gjv0jxduIhr6Zm4t07Y47d/s1600/myofascial+release+TFL.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjImTftSAuveZ7IG3cyALGbhFF6hKOOs2jAeQx4tdSVzKtKBL8eoD881La0SvcYdXm1r-AXeuXf_Nn0tJHcZVe3C680YqAZ8DjNkXzQHWAjLAnkwu9x1f4ef1gjv0jxduIhr6Zm4t07Y47d/s1600/myofascial+release+TFL.jpg" width="200" /></a></td></tr>
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沒看到任何成效;練了各式各樣的核心肌群運動也沒看到任何改善;去找很多人按摩、推拿、整脊的結果是除了本身的痛沒改善外又再加上按壓的痛感,痛上加痛,於是前來尋求我的協助。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 根據問診和仔細的理學評估發現<span style="color: orange;">左側臀中肌無力</span>,使下肢生物力學失常;再加上身體姿勢代償,</span></span><span style="font-family: 標楷體;"><span style="color: orange; font-size: x-large;">胸腰筋膜將胸椎旋轉功能鎖住</span></span><span style="font-family: 標楷體; font-size: xx-small;">,<span style="font-size: x-large;">導致右側肩膀肌肉因代償而被拉扯。所以每次跑步後就會產生敏感的左側肩膀疼痛感,大腿痛、膝蓋痛和右側蹠骨痛了。</span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 經過</span><span style="font-family: 標楷體;"><span style="color: orange;">redcord neurac懸吊系統針對左側臀中肌強化神經肌肉控制訓練</span>,以及<span style="color: orange;">放鬆左側肩胛骨的肌肉去解除代償</span>後,當場就讓右側<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7YtaCAQHwdf9vA24wPbMhxV4jkazQfGcu6w26r_sZ4kGOivl6-Zfx02WnNUGgEl1Ojm4FAat9lfRdA9VHVYw7w_G3TnrLtR74NfMwuyb_EQQ30kXn0VV4i-PTkjOfbtZHr9hsN1LQnQ46/s1600/maxresdefault.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7YtaCAQHwdf9vA24wPbMhxV4jkazQfGcu6w26r_sZ4kGOivl6-Zfx02WnNUGgEl1Ojm4FAat9lfRdA9VHVYw7w_G3TnrLtR74NfMwuyb_EQQ30kXn0VV4i-PTkjOfbtZHr9hsN1LQnQ46/s1600/maxresdefault.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">臀中肌訓練示意圖</td></tr>
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肩膀的敏感痛感消失,左側膝蓋也變得很輕鬆,走路時的右側蹠骨痛也減輕許多;陳先生在回診時更反應治療後的隔晚去跑步,發現可以跑更長距離才出現些微不適感,很開心的說終於找到真正可以改善他問題的方法了。</span><span style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;"> 很多人找我作治療時,通常我不會痛哪裡醫哪裡,因為那是發病導致的結果,不一定是病因,反而是在<b><span style="color: orange;">問診了解病情後,客觀的去做整體的理學評估、動作分析,去找出問題的根源,才有辦法解決惱人的痠痛</span></b>。</span></span><br />
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<span style="color: #444444; font-size: xx-small;"><span style="font-family: 新細明體;">Redcord neurac<span style="font-family: 新細明體;">、</span><span style="font-family: "times new roman";">ISAT</span><span style="font-family: 新細明體;">、懸吊運動、整脊、肌筋膜、</span></span><span style="font-family: 新細明體;">激痛點、按摩、肩頸痛、肩膀痛、手痛、下背痛、腰痛、髂脛束摩擦症候群、<span style="font-family: "times new roman";">ITB syndrome</span><span style="font-family: 新細明體;">、膝蓋痛、髕股骨軟化症、</span><span style="font-family: "times new roman";">PFPS</span><span style="font-family: 新細明體;">、腳痛、足背痛、蹠骨痛、</span></span><span style="font-family: 新細明體;">metatarsal pain<span style="font-family: 新細明體;">、大腿痠痛、臀中肌、臀大肌、椎間盤突出、跑步、馬拉松、核心肌肉訓練 跑步膝蓋痛 跑步肩膀痛 跑步腰痛怎麼治 跑步足底痛 足底筋膜炎 跑步足跟痛 膝蓋外側痛 膝蓋內側痛</span></span></span><span style="font-family: 新細明體; font-size: 10.5pt;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-11796484271595283122014-06-19T11:49:00.000-07:002015-10-18T06:38:49.487-07:00主管的哀愁----腰痛、手痠、腳發涼 (PART 2---案例分析)<div class="MsoNormal">
<span style="font-family: 標楷體;"><span style="font-size: x-large;">這個案需從<b><span style="color: orange;">脊骨力學</span><span lang="EN-US">(</span>骨盆和足踝力學<span lang="EN-US">)</span></b>和<b><span style="color: orange;">肌筋膜理論</span><span lang="EN-US">(Anatomy train)</span></b>去同時探討。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">由過去的文獻已經證實,<span style="color: orange;"><b>當薦椎旋轉時,會產生旋轉同側邊的功能性短腳</b>,而<b>腰椎第五節<span lang="EN-US">(L5)</span></b>勢必會因為代償而<b>往對側旋轉</b></span>,以及往上脊椎的一連串代償。</span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">在<span lang="EN-US">1969</span>年,<span lang="EN-US">TePoorten</span>學者也提出,當有薦椎旋轉時可能同時會產生<span lang="EN-US">T10/11</span>旋轉角度<span lang="EN-US">(ROM)</span>變小,<span lang="EN-US">T3/4</span>周圍軟組織異常<span lang="EN-US">(</span>變緊<span lang="EN-US">)</span>,<span lang="EN-US">C0/C1/C2</span>旋轉功能減少。</span><span lang="EN-US" style="font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">然而,每位個案情況都不一樣,這位患者的<span style="color: orange;"><b>左側梨狀肌<span lang="EN-US">(piriformis m.)</span>偏緊,薦椎往右旋轉<span lang="EN-US">(Right on Right)</span>,</b>同時這位患者的<b>右腳是功能性偏短</b>,在<b><span lang="EN-US">L4/L5/S1</span>、<span lang="EN-US">T10/T11</span>、<span lang="EN-US">T4/T5</span>有壓痛感</b>,症狀則是左腰痛、右手痠,雙腳發涼。</span>也可從過去學者的研究發現映證,有諸多相似之處。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">從足踝力學出發,可以知道功能性短腳那一側,前脛肌會因為代償性足踝內旋<span lang="EN-US">(foot pronation)</span>而有過度拉扯的現象,同側膝蓋外翻<span lang="EN-US">(knee valgus)</span>,骨盆同側旋轉<span lang="EN-US">…<span style="color: #f9cb9c;">(</span></span><span style="color: #f9cb9c;">不同的解剖面出發會有許多不同的代償,就不在此贅述</span><span lang="EN-US"><span style="color: #f9cb9c;">)</span>…</span>頭會往對側側彎,而<span lang="EN-US">C0/C1/C2</span>的偶合機制<span lang="EN-US">(couple motion)</span>,會讓頭往同側旋轉。<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://fixflatfeet.com/wp-content/uploads/2013/03/Pronation-Effects.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://fixflatfeet.com/wp-content/uploads/2013/03/Pronation-Effects.jpg" height="330" width="400" /></a></td></tr>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">換句話說,這位個案是<b><span style="color: orange;">右側功能性短腳</span></b>,代償的結果可能會讓<b><span style="color: orange;">右膝偏外翻、頭偏左側彎和右轉</span></b>,導致患者有<span style="color: orange;"><b>膝蓋磨擦感和頭左轉角度受限</b>。</span><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">但是代償機制會上下左右影響,往往因人而異,從骨盆和足踝力學模型解釋,僅做臨床一定層度的參考。我認為<span style="color: lime;">以脊骨力學來看尚無法完全解釋為何放鬆脛前肌可以改善頭左轉的角度受限。</span><span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">所以我們需要再結合肌筋膜理論,筋膜具有力量傳遞的效果,當一邊收縮變緊時,另一邊就會被拉扯,循一定軌道互相牽制互相影響,就像列車鐵軌一般。
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">最符合這位個案狀況的就是肌筋膜列車裡面的<span style="color: orange;">前旋線<span lang="EN-US">(Spiral line)</span>模型</span>。可能<span style="color: orange;"><b>右側前脛肌<span lang="EN-US">(Tiabialis ant.)</span>太緊,繼而影響右側頭夾肌<span lang="EN-US">(Splenius m.)</span>張力增加,間接限制了頭左轉的角度</b>。<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://static.squarespace.com/static/5005f01224acbd73a09dbaaa/t/511c0435e4b0e13018ebd611/1360790587656/DSCN2633.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://static.squarespace.com/static/5005f01224acbd73a09dbaaa/t/511c0435e4b0e13018ebd611/1360790587656/DSCN2633.JPG" height="400" width="287" /></a></td></tr>
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">此旋線也會誘發膝蓋往內旋<span style="color: #fce5cd;">(詳細內容請參考Anatomy train一書,在此不多加贅述)</span>,可直接與上述的脊骨力學相呼應。<span lang="EN-US"><o:p></o:p></span></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: 標楷體;"> </span><span style="font-family: 標楷體;">但這都是事後分析解釋,若你問我臨床上一開始怎麼知道要處理脛前肌改善頭部旋轉角度<span lang="EN-US">?? </span><span style="color: lime;">老實說,我也不知道</span>,很多時候你只能<span style="color: lime;">土法煉鋼</span>仔細去找出所有可能影響的地方,再一個一個去測試。所以,我還要提供一個<span style="color: magenta;">『<b>平衡</b>』</span>的概念。<span style="color: magenta;">當身體受到外來的刺激<span lang="EN-US">(</span>包括姿勢不良、肌肉勞損、受傷<span lang="EN-US">…</span>等<span lang="EN-US">)</span>,可能會產生一連串的反射或代償試圖去平衡身體的狀況,當身體無法再平衡、無法再負荷的時候就會產生症狀,那無法再平衡的地方有可能位於症狀區域也有可能遠離症狀區域,你必須去找出來</span><span lang="EN-US"><span style="color: magenta;">!!!</span><o:p></o:p></span></span></span></div>
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<span style="font-family: 標楷體;"><span style="font-size: x-large;">而這個個案也只是剛好放鬆脛前肌可以改善頸部功能罷了,變成一個臨床經驗,但卻不一定適用於下一個病人<span lang="EN-US">…</span>。</span><span lang="EN-US"><o:p></o:p></span></span><br />
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<span lang="EN-US" style="font-family: "Frutiger-Roman","sans-serif";">文獻參考:1. TePoorten
BA. The piriformis muscle. </span><i><span lang="EN-US" style="font-family: "Frutiger-Italic","sans-serif";">J Am Osteopath Assoc</span></i><span lang="EN-US" style="font-family: "Frutiger-Roman","sans-serif";">.
1969;69:150-</span><span style="font-family: Frutiger-Roman, sans-serif;">160.</span></div>
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<span style="font-family: Frutiger-Roman, sans-serif;"> 2. Anatomy Train 2nd Edition.</span></div>
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<span style="font-family: Frutiger-Roman, sans-serif;"> 3. P</span><span style="font-family: Frutiger-Roman, sans-serif;">odiatry Biomechanics</span></div>
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<span style="font-size: x-large;">https://www.jhspt.com</span><br />
<span style="font-size: x-large;">https://www.facebook.com/linphysiotherapy</span><br />
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<span style="color: #141414; font-family: 標楷體; font-size: xx-small;">林晉熯
物理治療 運動醫學 臨床徒手醫學 脊骨神經醫學 足踝力學 脊骨矯正 肌骨平衡醫學 脊髓神經壓迫 氣血不通 感覺異常 深層肌腱反射 自然療法 肌筋膜理論 肌筋膜放鬆
按摩 腰酸背痛 肩頸痠痛 手痠麻 腳發涼冰凍感 骨盆歪斜 氣血不痛怎麼辦 手麻怎麼辦 腳麻怎麼辦 腰酸背痛怎麼治療 腳發涼怎麼辦 整脊 梨狀肌症候群</span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-32921344118366076302014-06-19T06:24:00.002-07:002015-10-20T05:23:51.644-07:00主管的哀愁----腰痛、手痠、腳發涼 (PART 1--案例分享)<div class="MsoNormal">
<span style="font-size: x-large;">http://www.jhspt.com</span><br />
<span style="font-size: x-large;">http://www.facebook.com/linphysiotherapy</span><br />
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<span style="font-size: x-large;"><span style="font-family: 標楷體;">作者:林晉熯 院長</span></span><br />
<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 晉熯脊骨物理治療所</span></span><br />
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<span style="font-size: x-large;"><span style="font-family: 標楷體;"> 做徒手脊椎治療久了,會發現,腰痠痛和頸部痠痛大多常會跟隨著發生。</span><span lang="EN-US" style="font-family: 'Times New Roman', serif;"><o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="http://www.painsolution.us/wp-content/uploads/2012/11/Pain-In-Lower-Left-Side-300x253.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://www.painsolution.us/wp-content/uploads/2012/11/Pain-In-Lower-Left-Side-300x253.jpg" height="168" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">示意圖http://www.painsolution.us/</td></tr>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";"> 這次要分享的案例是約五月中旬找我尋求協助的</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">58</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">歲女性財務主管。主訴是<b><span style="color: lime;">右手痠、左側腰痠痛、右膝</span></b>在彎曲時會有骨頭碰骨頭的<b><span style="color: lime;">摩擦異樣感</span></b>,以及<span style="color: lime;"><b>雙腳腳趾有冰凍感</b>。</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="http://imbuebody.com/wp-content/uploads/2012/05/LatDorsi.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://imbuebody.com/wp-content/uploads/2012/05/LatDorsi.png" height="341" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">示意圖 http://imbuebody.com</td></tr>
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<span style="font-family: 標楷體; font-size: small;"> 她告訴我說:「除了沉浸在工作之外,腰痛、手痠似乎沒間斷過,而且<span style="color: orange;">雙腳的腳趾有冰凍感</span>,就連現在熱得要死的夏天,我都還穿著厚棉襪,就像是<span style="color: orange;">氣血不通</span>的感覺似的</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: x-large;">…</span><span style="font-family: 標楷體; font-size: small;">。去看過很多醫生,包括每星期開車到桃園八德去給中醫針灸、找復健科作頸腰椎牽引、神經內科、甚至身心內科</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: x-large;">…</span><span style="font-family: 標楷體; font-size: small;">吃了抗憂鬱藥物</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: x-large;">…</span><span style="font-family: 標楷體; font-size: small;">都沒有獲得改善</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: x-large;">…</span><span style="font-family: 標楷體; font-size: small;">。尤其是在下班後要離開座位時發現,我的<span style="color: orange;">手和腰快感覺到不是自己的一樣</span>。最近發現<span style="color: orange;">右腳膝蓋關節也有怪怪的摩擦感</span><span lang="EN-US">…</span>」</span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">過去的</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">X</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">光和</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">MRI</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">檢查發現<span style="color: lime;">腰椎第四五節有輕微退化</span>。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體; mso-hansi-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體; mso-hansi-font-family: 標楷體;">X</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">光檢查發現膝蓋沒有問題</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,而個案</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">沒有作過頸部的光學檢查。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">也做過全身健檢,包括抽血檢查過也沒有任何問題。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體; mso-hansi-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">無心臟病、糖尿病、高血壓或任何特殊疾病的病史。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">經過理學評估後發現</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">:<o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">坐姿下,頸部往右轉</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">+</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">右側彎</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">+</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">後仰明顯誘發出右肩頸痛和手痠的症狀。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">雙側頸部周邊的肌肉張力較高,尤以右側斜方肌和斜角肌更明顯。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">坐姿下,頭向左轉時,明顯的角度較小</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">(</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">約</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">45</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">度</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">,有代償性肌肉收縮。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">站姿下,將腰轉的跟麻花繩一樣,腰部功能性動作都沒有症狀變化。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">在趴著的時候,在</span><span style="color: lime;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">L4/5</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">L5/S1</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">T10/11</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">T4/5</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">有明顯壓痛點。</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">雙側臀大肌偏緊,尤以<span style="color: lime;">左側梨狀肌</span>有明顯<span style="color: lime;">激痛點</span>。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">薦椎偏右旋轉</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體; mso-hansi-font-family: 標楷體;">(Right on Right)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman";">。</span></span><br />
<span style="font-size: x-large; text-indent: -18pt;"><span style="font-family: Times New Roman, serif;">8. </span></span><span style="font-family: 標楷體; font-size: small; text-indent: -18pt;">功能性長短腳,右短左長。</span><br />
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></div>
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"> 主訴有<span style="color: lime;">雙腳冰凍感</span>,但觸診時卻發現皮膚是溫熱的,與週遭皮膚溫度、顏色沒多大差別,雙腳也沒有靜脈曲張現象,抓捏雙側小腿肚也沒有壓痛感。所以<span style="color: lime;">暫時排除掉周邊血管循環問題</span></span><span style="color: lime;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">(</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">譬如</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">DVT)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">。</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">因為這種感覺異常屬於不正常的神經症狀,再進一步檢測<span style="color: magenta;">深層肌腱反射</span>,發現</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">…<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="font-size: x-large;">DTR <b><span style="color: lime;"> </span><span style="color: magenta;">Knee
jerk R/L (++/+++)</span><o:p></o:p></b></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="font-size: x-large;"> Triceps
reflex R/L (++/++)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="font-size: x-large;"> Biceps
reflex R/L (++/++)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="font-size: x-large;"> Brachioradialis R/L (++/++)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><b><span style="color: magenta;">左側膝反射有明顯增加</span></b>,其餘正常。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">然而在膝關節作</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">STTT</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">檢測後,沒發現什麼異常。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">綜合以上,發現</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">…<o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="color: magenta; font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">判斷雙腳趾冰凍感等異常感覺的問題來自胸椎。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">忙碌工作後的<span style="color: magenta;">手痠來自頸椎問題的神經症狀。</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: magenta;">左腰痠痛</span>的症狀可能來自於<span style="color: magenta;">左側梨狀肌太緊和薦髂關節功能異常</span>所致。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman';"> <span style="color: orange;">
</span></span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: orange;">膝蓋有摩擦感的問題當下還不知道</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="color: orange;">…</span><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">於是開始處理當下所發現的問題</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">…<o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">針對<span style="color: lime;">頸椎右側</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="color: lime;">C5</span></span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">作動態關節鬆動術</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">(MWM)</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">,配合右轉</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">+</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">側彎</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">+</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">後仰的動作可<span style="color: lime;">改善肩頸痛的症狀</span>。再幫頸部作脊骨調整和肌筋膜放鬆來舒緩肌肉的緊張。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">舒緩梨狀肌和調整<span style="color: lime;">薦髂關節</span>後,<span style="color: lime;">右腰痛</span>的症狀也隨之解除。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-size: x-large;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">對胸椎作治療性測試發現,壓</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">T10</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">時合併有悶痛感,對</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="color: lime;">T10</span></span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: lime;">作鬆動術後讓患者的雙腳冰凍感有顯著性改善</span>。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">可是</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">……</span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">患者的<span style="color: orange;">膝蓋摩擦感</span>,以及<span style="color: orange;">頭左轉的旋轉角度不夠</span>的問題還是沒解決</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;">…<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://www.suddenkneepain.com/wp-content/uploads/2013/11/right-knee-pain.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://www.suddenkneepain.com/wp-content/uploads/2013/11/right-knee-pain.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">http://www.suddenkneepain.com/</td></tr>
</tbody></table>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"> 第二次治療時,也先依循第一次的治療方式先處理手痠腰痛的症狀。同時再更仔細的找尋所有可能的原因,包含身體所有的激痛點和肌肉關節緊繃處。</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><o:p></o:p></span></span></div>
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<tr><td style="text-align: center;"><a href="http://photos2.demandstudios.com/dm-resize/photos.demandstudios.com/getty/article/106/242/149613851_XS.jpg?w=400&h=10000&keep_ratio=1" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://photos2.demandstudios.com/dm-resize/photos.demandstudios.com/getty/article/106/242/149613851_XS.jpg?w=400&h=10000&keep_ratio=1" height="213" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">示意圖http://www.livestrong.com/</td></tr>
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<span style="font-size: x-large;"><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"> 由以上治療過程就可以知道這個患者可以說是幾乎全身都有問題,但是偏偏臨床上這類的患者又很多,也常會發現<span style="color: lime;">腰椎背痛的患者常漸漸伴隨著肩頸也容易痠痛的現象</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="color: lime;">…</span></span><span style="font-family: 標楷體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span style="color: lime;">可以說是脊椎一連串代償的系統性問題</span>,不僅會產生擾人的症狀,甚至有部分功能性動作異常,這都需要我們審慎視之</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: 標楷體;"><span style="font-size: x-large;">…</span><o:p></o:p></span><br />
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<span style="color: #141414; font-family: 標楷體; font-size: xx-small;">林晉熯
物理治療 運動醫學 臨床徒手醫學 脊骨神經醫學 足踝力學 脊骨矯正 肌骨平衡醫學 脊髓神經壓迫 氣血不通 感覺異常 深層肌腱反射 自然療法 肌筋膜理論 肌筋膜放鬆
按摩 腰酸背痛 肩頸痠痛 手痠麻 腳發涼冰凍感 骨盆歪斜 </span><span style="font-size: xx-small;">手痠麻 腳發涼冰凍感 骨盆歪斜 氣血不痛怎麼辦 手麻怎麼辦 腳麻怎麼辦 腰酸背痛怎麼治療 腳發涼怎麼辦 整脊 梨狀肌症候群</span></div>
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Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-25958988206819410162013-12-30T08:13:00.001-08:002013-12-30T08:14:23.825-08:00運動前後伸展好重要<div class="separator" style="clear: both; text-align: center;">
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<br />Anonymoushttp://www.blogger.com/profile/05292509183720344389noreply@blogger.com0tag:blogger.com,1999:blog-6584628082728549975.post-8311608044324423252013-12-16T18:52:00.002-08:002013-12-16T18:57:10.785-08:00《太陽報》職勞成疾 (肩頸痠痛、腰痠背痛)<h3 class="post-title entry-title" itemprop="name">
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">頸椎說:「都是手指你的錯,主人每天在Office日夜打電腦,手腕長期彎曲,不但我頸椎,還有其他身體部位都出現職業勞損。」</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">手指說:「怎會是我的錯?頸椎你不要忘記,主人終日與電腦為伍,頭部經常向前傾,對頸椎你造成好多壓力,所以引致職業勞損的兇手是你才真!」</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">肩膊說:「沒錯,主人在Office長時間坐姿不正確,好大機會變成頸椎錯位,到時不但周身痛,手指更會麻痹呢!」</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">腰部說:「大家不要互相指摘啦,主人的職業勞損問題其實源自多個方面,我們人人都有責。要紓緩及預防痛症,必須養成正確的生活習慣,如坐姿正確、不要翹腳、坐時要緊貼椅背等。」</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">頸椎是由7節脊椎骨所組成,支撐着約12磅重的頭部,每天8小時頭部都處於向前傾的姿勢,壓力之重可想而知,難怪脊骨神經科醫生林福傑指,辦公室職業勞損以頸部居多。輕則頸肩痠痛,有時連轉動頭部的幅度亦受到影響,舉頭時感到不舒服。重則可引致頸椎錯位,一旦頸部神經線被壓着,便會出現手臂肌肉痛、手指麻痹
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">經常使用電腦的文職人士如金融銀行業、會計、記者等,以及手部或頸部經常用力的職業如攝影師、樂器演奏家等,都較易患上頸椎錯位。要減輕或預防勞損,使用電腦和手提電話時,應避免頭部向前傾,坐姿正確,背部緊貼椅背,不要翹腳,耳珠要與肩膊成直線。持續坐下工作的話,每隔半小時要起身走走,稍作休息。</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">你在辦公室的坐姿是怎麼樣?會否趴在工作枱上,抑或上半身離開椅背,頭部過於向前傾,形成寒背的坐姿?其實長時間不正確的工作坐姿,不但肩膊勞損,更有機會
引致脊骨錯位、坐骨神經痛及腰椎間盤突出等。為何坐姿不正確?有可能是辦公室環境不當所致,如工作枱設計不符合人體工學、電腦屏幕放置太遠等。亦有可能是
人為因素,如翹腳、寒背、腰部不挺直等。</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0); font-family: 'Helvetica Neue Light',HelveticaNeue-Light,helvetica,arial,sans-serif;">要紓緩痛症,大家不妨從工作間入手。座椅要調校至適當的高度,電腦螢幕放在正前方與眼睛成水平線,人便不用彎腰低頭也能看到螢光幕或文件。使用電腦時,頭部
要避免向前傾,腰背要挺直並緊靠椅背,不要翹腳,不要打側坐,有需要時可放一個軟墊在腰部,以減輕壓力。坐得太久,同樣亦最好每隔半小時左右起身走走。</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">俗
稱「電腦手」的腕管綜合症亦是常見毛病。腕管位於手腕內,正中神經和手部肌腱經此通道,而伸延入手掌。腕管內空間相當狹窄,重複性的手腕動作,易令腕管內
的肌腱發炎、腫脹,壓迫着正中神經,令拇指、食指、中指和半截無名指出現刺痛、灼熱及麻痹,嚴重的更會手腕無力。文職、收銀員、機械維修員等,都是這病的
高危職業。要紓緩或預防徵狀,關鍵在於避免手腕持續處於彎曲的姿勢,盡量減慢手腕動作的速度,力量亦要減少,多點讓手部休息。</span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">此外,一些職業如果需要長期重複使用手指或手腕,如打字員、美容師、髮型師、水喉匠、廚師等,則較易患上手腕腱鞘炎或狹窄性肌腱滑膜炎,即俗稱「媽媽手」。
初期手腕部位出現疼痛,其後會感到腫脹、輕微灼傷。每當轉動手腕、拇指反覆伸直或屈曲時,痛楚更會加劇。適當的拇指及腕部休息是紓緩痛症的上策。嚴重的則
需要尋求專業的檢查及治療,如刺激血液循環的超聲波治療。</span></span></div>
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<span style="color: lime;"><span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">運動示範:放鬆頸肩</span></span></span></h2>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">1. 坐在椅上,腰要挺直,右手放在背脊,左手按在頭頂,然後慢慢拉向左邊,動作維持10秒。換轉另一邊,重複動作。每組重複做10次,最理想每小時做1次。</span></span><br />
<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">功效:<span style="color: orange;">伸展肩頸及手臂肌肉,增強手部活動能力。</span></span></span></div>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">2. 腰要挺直,雙手放於背後,十指緊扣,並向上提起,手肘保持伸直,動作維持10秒。重複動作,每組重複做10次。亦可坐在椅上進行運動,這時背脊就要緊貼椅背。</span></span><br />
<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">功效:<span style="color: orange;">紓緩頸肩的繃緊肌肉,伸展手腕及手指。</span></span></span></div>
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<span style="color: lime;"><span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">伸展下背</span></span></span></h2>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">坐在椅上,背脊緊貼椅背。扭轉上身,雙手抓着椅背,維持動作10秒,慢慢轉向另一邊,同樣維持10秒。每組重複做10次。</span></span><br />
<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">功效:<span style="color: orange;">伸展下背及腰外側的肌肉</span>。</span></span></div>
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<span style="color: lime;"><span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">護腕運動</span></span></span></h2>
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<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">伸直左手,左手向上與前臂成90度角,以右手輔助保持動作10秒。然後手腕反方向向下與前臂成90度角,保持動作10秒,每組重複做10次。</span></span><br />
<span style="font-size: x-large;"><span style="background-color: rgba(255, 255, 255, 0);">功效:<span style="color: orange;">伸展前臂及手腕肌肉及韌帶。</span></span></span></div>
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<span style="font-size: small;">文章轉自 <a href="http://chiropractorhk.blogspot.tw/2013/12/blog-post_1146.html?m=1">http://chiropractorhk.blogspot.tw/2013/12/blog-post_1146.html?m=1</a></span><br />
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